Humans ; Cavernous Sinus/surgery* ; Endoscopy ; Neoplasms

OBJECTIVETo investigate the indications of the pretemporal transcavernous approach for cavernous sinus tumors resection and design individually tailored surgery according to the extent of tumors and operation requirements.

METHODSA retrospective analysis of clinical data, surgical outcomes and complications in a series of 31 cases with cavernous sinus tumor operated via the individually tailored pretemporal transcavernous approach between May 2012 and September 2015 in Department of Neurosurgery, Xiangya Hospital, Central South University. There were 13 male and 18 female patients, aging from 17 to 67 years with a mean of (41±14) years. The patients included 18 cases of shwannomas, 4 cases of meningiomas, 3 cases of cavernous hemangiomas, 2 cases of invasive pituitary adenomas, 1 case of chordoma, 1 case of chondroma, 1 case of recurrent teratoma, 1 case of metastatic nasopharyngeal carcinoma. The first followed-up visit was on the 3(rd) month after surgery, and if tumor progression or recurrence was observed on MRI, the Gamma knife treatment was recommended, the patient was followed up every 6 months, otherwise the patient was followed up again 6 months later, then, every 12 months.

RESULTSGross total removal of tumors was achieved in 22 cases of 31 patients (71.0%), containing 17 cases of shwannomas, 3 cases of hemangiomas, 1 case of chondroma, 1 case of teratoma; subtotal removal in 6 cases (19.3%), including 3 cases of meningiomas, 1 case of pituitary adenoma, 1 case of chordoma, 1 case of metastatic carcinoma; partial removal in 3 cases (9.7%), comprising 1 case of meningioma, 1 case of recurrent shwannoma, 1 case of recurrent pituitary adenoma. The symptoms of cranial never aggravated in 5 cases, the new postoperative cranial never palsy was observed in 7 cases. There was no surgical mortality, intracranial hematoma, intracranial infection and cerebrospinal fluid leakage cases, ect. Twenty-eight cases were followed up for more than 3 months (3 to 40 months), 1 case of chordoma had tumor progression; the nerve function was restored in 5 cases, among the 12 cases with postoperatively new occurred or deteriorated cranial nerve paralysis.

CONCLUSIONSThe pretemporal transcavernous approach can be used to resect tumors limited in cavernous sinus or tumors simultaneously involving the cavernous sinus and its vicinity areas, it can be individually tailored based on the extent and exposure of the tumor. This approach can improve the surgical results in terms of high tumor resection rate, less complication, is an ideal approach for cavernous sinus tumor resection.

Adenoma ; surgery ; Adolescent ; Adult ; Aged ; Cavernous Sinus ; pathology ; surgery ; Chordoma ; surgery ; Female ; Hemangioma ; surgery ; Humans ; Magnetic Resonance Imaging ; Male ; Meningioma ; surgery ; Middle Aged ; Neoplasm Recurrence, Local ; Pituitary Neoplasms ; surgery ; Postoperative Period ; Radiosurgery ; Retrospective Studies ; Young Adult

In the Department of Oral and Maxillofacial Surgery, patients with trismus can be easily identified. If the cause of trismus is infection of the masticatory space near the pterygoid plexus, the possibility of cavernous sinus thrombosis should be considered. We report the case of a patient who presented with limited mouth opening and progressed to cavernous sinus thrombosis, along with a review of the relevant literature.
Cavernous Sinus Thrombosis* ; Focal Infection, Dental ; Humans ; Mouth ; Surgery, Oral ; Trismus*

OBJECTIVETo investigate the medium- and long-term outcomes of multisession cyberknife radiosurgery intreating cavernous sinus hemangiomas (CSH).

METHODSBetween January 2008 and February 2012, 45 patients with CSH, including 35 female and 10 male patients with a mean age of 53 years (range: 26-80 years), underwent multisession cyberknife radiosurgery. The mean diameter of the CSH was 47.0 mm (range: 23.0-75.0 mm). The tumor volume ranged from 2.9 to 140.1 cm³, with a mean of 40.1 cm³. Eleven giant CSH with tumor volume ≥ 40.0 cm³ were irradiated by cyberknife in 4 fractions, 28 large tumors with tumor volume 10.0-40.0 cm³ in 3 fractions, 4 tumors with tumor volume 5.0-10.0 cm³ in 2 fractions, 2 small tumors with tumor volume ≤ 5.0 cm³ in 1 fraction. After the treatment, all patients had regular clinical and radiological follow-up at 6-month intervals. A combination of the neurologic examination and MRI information was used to evaluate the overall response.

RESULTSAll patients were followed up for 22-70 months with a mean of 37.7 months. One patient died of stroke 3 years post cyberknife, but the follow-up MRI showed that the CSH shrank in volume. Eight patients with giant CSH had slight headache after finishing cyberknife radiosurgery, and relieved with mannitol and dexamethasone treatment. Neurological deficits in patients had improved or disappeared at 6 to 12 months post cyberknife. None of these patients showed any deterioration in symptoms or new cranial nerve deficits during the follow-up. Latest follow-up imaging demonstrated that tumors decrease > 80% in 15 patients, > 60% to 80% in 18 patients (including the death patient), 40%-60% in 12 patients post cyberknife. Two patients reported occurrence of seizures and maintaining seizure control after antiepileptic drugs administration.

CONCLUSIONSMultisession cyberknife radiosurgery is confirmed to provide medium and long-term local tumor control and symptom improvement. It is a safe and effective treatment modality for CSH, and may serve as a promising treatment option in the future.

Adult ; Aged ; Aged, 80 and over ; Cavernous Sinus ; pathology ; surgery ; Cranial Nerves ; physiopathology ; Female ; Hemangioma ; surgery ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Radiosurgery ; methods ; Treatment Outcome ; Tumor Burden

OBJECTIVETo evaluate the management and outcomes in patients with giant symptomatic cavernous sinus aneurysms who underwent aneurysms trapping with bypass, proximal carotid occlusion and aneurysms trapping.

METHODSTwenty-three patients with giant symptomatic cavernous sinus aneurysms underwent surgery between February 2007 and March 2013, 3 cases were male and 20 cases were female patients, the age of the patients ranged between 24 and 68 years, mean age was 54.7 years. The pre-operative digital subtraction angiography (DSA) and ballon occlusion test (BOT) were performed to confirm the diagnosis and identify hemodynamic reserve with carotid occlusion, and the aneurysms trapping with bypass, aneurysms trapping and proximal occlusion of the internal carotid artery were performed according to BOT results. During the surgery, the neurophysiological monitoring and the intraoperative CT perfusion were used. The follow-up by DSA or CT angiography were made.

RESULTSSeventeen patients underwent aneurysms trapping with bypass, 1 underwent aneurysms trapping and 5 underwent proximal occlusion of the internal carotid artery. After surgery, symptom improved in 4 cases, did not change in 10 cases, and new neural function deficit developed in 9 cases. The follow-up period were 3 months to 75 months. Two patients were lost. The Glasgow Outcome Scale of last follow-up were 5 in 19 patients, 3 in 1 patient and 1 in 1 patient.

CONCLUSIONSThe aneurysms trapping with bypass and proximal occlusion of the internal carotid artery are effective and reliable procedure for treatment of giant symptomatic cavernous sinus aneurysms in selected patients after evaluation of the pre-operative BOT, intra-operative neurophysiological monitoring and the intraoperative CT perfusion.

Adult ; Aged ; Carotid Artery Diseases ; surgery ; Carotid Artery, Internal ; surgery ; Cavernous Sinus ; surgery ; Female ; Humans ; Intracranial Aneurysm ; surgery ; Male ; Middle Aged ; Treatment Outcome

OBJECTIVETo study the effectiveness of treating giant pituitary adenomas invading cavernous sinus with neuroendoscopy assisted by multiple techniques.

METHODSA total of 72 patients who underwent neuroendoscopic surgery and 55 patients who underwent microscopic surgery for giant pituitary adenomas were enrolled in this retrospective analysis. Both groups received expanded endoscopic endonasal transsphenoidal approach, intraoperative application of navigation, and Doppler.The clinical data of two groups were compared.

RESULTSThe two groups were significantly different in total tumor removal rate, operation time, postoperative nasal patency, and postoperative recurrence rate (P=0.004, P=0.0003, P=0.000, and P=0.002, respectively), whereas the cerebrospinal fluid leakage, postoperative diabetes insipidus, and cranial nerve injury were not significantly different (P > 0.05).

CONCLUSIONSExpanded neuroendoscopic endonasal transsphenoidal approach assisted by multiple techniques is the preferred surgical method for giant invasive pituitary adenomas invading cavernous sinus.The lateral cavernous sinus approach and the further molecular biology research will bring more options for the treatment of invasive pituitary adenomas.

Adenoma ; pathology ; surgery ; Adult ; Aged ; Cavernous Sinus ; pathology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Neuroendoscopy ; methods ; Pituitary Neoplasms ; surgery ; Retrospective Studies ; Treatment Outcome

Epidermoid tumor of the cavernous sinus is rare. The aim of this case report is to discuss the role of neuroendoscopes in the removal of such lesions. A 21-year-old man presented with 6-year history of progressive headache, diplopia, and visual disturbance. Work-up revealed an epidermoid tumor located in the right cavernous sinus. An extradural transcavernous approach was utilized via a traditional frontotemporal craniotomy with endoscopic assistance. The postoperative course was uneventful with immediate improvement of the patient's headache. Postoperative magnetic resonance imaging demonstrated complete removal of the tumor. There were no signs of recurrence during a 2-year follow-up period. The endoscope is a useful tool for removing epidermoid tumors from the cavernous sinus and enhances visualization of areas that would otherwise be difficult to visualize with microscopes alone. Endoscopes also help minimize the retraction of neurovascular structures.
Adult ; Cavernous Sinus/*pathology/*surgery ; Endoscopy/*methods ; Epidermal Cyst/*pathology/*surgery ; Humans ; Male ; Microsurgery/*methods ; Young Adult

OBJECTIVETo summarize the curative effect of surgically treated large or giant cavernous sinus hemangiomas (CSH) via epidural approach.

METHODSFrom June 1999 to June 2011, 19 cases of CSH including 15 female and 4 male patients, ranging from 26 to 70 years (mean 45.3 years) were retrospectively reviewed. Ptosis/ocular motility disorders (10 cases), headache/ophthalmalgia (7 cases), decreased visual acuity (7 cases) and facial hyperesthesia (4 cases) were the most common presenting complaints. The epidural approach was taken and the tumor dissection was performed at the interval between trochlear nerve and ophthalmic nerve and the interval between ophthalmic nerve and maxillary nerve. The curative effect was followed up regularly.

RESULTSGross total resection was attained in 13 cases, near-total resection in 4 cases, subtotal resection in 1 case and partial resection in 1 case. The follow-up period was between 6-144 months (mean 41.5 months). The results of last follow-up were as follows: among the 10 patients with ptosis/ocular motility disorders, complete remission was achieved in 5, improvement in 2, no change in 2 and lost follow-up in 1. Facial hypoesthesia symptom got complete remission in 2 patients and partial remission in the other 2 patients. The other symptoms mentioned above were all relieved. One patient got complication with impairment of vision and ocular motility disorders.

CONCLUSIONSCombined with skilled skull base techniques, surgical treatment of large or giant CSH via epidural approach is an effective method and the preservation of cranial nerves could be attained to an acceptable level.

Adult ; Aged ; Cavernous Sinus ; pathology ; Female ; Follow-Up Studies ; Hemangioma ; surgery ; Humans ; Male ; Middle Aged ; Neurosurgical Procedures ; methods ; Retrospective Studies ; Treatment Outcome

OBJECTIVESTo review the preliminary clinical experience with high-field-strength intraoperative magnetic resonance imaging (iMRI) suite with neuronavigation system in the pituitary adenoma operation with transsphenoidal approach.

METHODSFrom March 2009 to December 2010, 31 patients [range, 29 - 76 years, mean age (47 ± 11) years]of pituitary adenoma were operated with transsphenoidal approach and intraoperatively with a movable 1.5 T high-field-strength iMRI suite in combination with neuronavigation system. Tumor size was 1.8 - 7.3 cm, mean (3.5 ± 1.2) cm. Twenty-five cases were non-functional pituitary adenoma, 4 cases were prolactin-secreting pituitary adenoma, 2 cases were growth hormone-secreting pituitary adenoma. Thirty patients' resection with transnasal transsphenoidal approach were performed, one patient with transoral transsphenoidal approach was performed.

RESULTSIn 12 cases of 30 patients who planed to totally remove tumor, iMRI had revealed residual lesions and resulted in the change of the surgical strategy, 2 invasive cavernous sinus cases no further resection of the tumor because of internal carotid artery encasement, the other 10 cases resected further, eventually. Finally, 8 cases were totally removed. The ratio of total removal tumor was enhanced to 86.7% (26/30) from 60.0% (18/30). There was no perioperative mortality.

CONCLUSIONSHigh-field-strength iMRI suite with neuronavigation system provides valuable information of tumor resection that allows intraoperative modification of the surgical strategy. It could be very helpful to maximize the resection of the pituitary adenoma and minimize the injury to neurological function.

Adenoma ; surgery ; Adult ; Aged ; Cavernous Sinus ; surgery ; Female ; Humans ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Monitoring, Intraoperative ; methods ; Neuronavigation ; methods ; Pituitary Neoplasms ; surgery

BACKGROUNDSurgery of pituitary adenomas invading cavernous sinus has always been thought as a challenge due to the complex anatomical structures and high risk of complications. The purpose of this study was to evaluate endoscopic transsphenoidal approach to pituitary adenomas invading cavernous sinus.

METHODSThe clinical data of 22 patients who admitted to Xuanwu Hospital with pituitary adenomas invading cavernous sinus were analyzed retrospectively. All patients underwent endoscopic transsphenoidal surgery. To expose the surgical field sufficiently, the opening of sellar floor was exceeded the bone overlying the invaded cavernous sinus, and synthetic dura was used to repair and strengthen the sella floor for preventing the leak of cerebrospinal fluid.

RESULTSAmong 22 patients, total resection was achieved in 14, subtotal resection in 5, and partial resection in 3; no patient underwent insufficient resection. Visual symptoms improved in 7 of 9 patients. In one patient diplopia disappeared. Headache was relieved to various extents in all patients. No serious complications were found. Patient's hospital stay ranged from 7 to 20 days.

CONCLUSIONThese data suggest that the endoscopic transsphenoid approach is a safe, minimally invasive, and efficient surgical technique, which might be an important therapeutic strategy for the pituitary adenoms invading cavernous sinus.

Adenoma ; pathology ; surgery ; Adult ; Aged ; Cavernous Sinus ; pathology ; Endoscopy ; methods ; Female ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Neoplasm Invasiveness ; Pituitary Neoplasms ; pathology ; surgery ; Sphenoid Bone ; surgery