cavernous sinus meningioma survival rate

Cranial neuropathy can be solved by treatment, particularly those of recent onset DeMonte F, Smith H, Al-Mefty O (1994) Outcome of aggressive removal of cavernous sinus meningiomas. Correa SF, Marta GN, Teixeira MJ. One hundred and seventeen patients with cavernous sinus meningiomas had LINAC radiosurgery in the period 1993-2007. However, there are very few publications about the long-term disease-free survival rates and monitorization of the neurological abnormalities, radiological findings, and toxicity Patients' age ranged between 31 and 86 years (mean 57). 1993 May;160(5):1083-8. Complete resection was achieved in 41.5% of cases and was not significantly associated with functional CN recovery. Abdel-Aziz KM, Froelich SC, Dagnew E, Jean W, Breneman JC, Zuccarello M, van The mean tumor volume was 7 cc. The vicinity of the tumor with the vital and highly functional neurovascular structures, tumor extensions into the basal cisterns and skull base structures, and the arterial vascularization and venous drainage pathways, as they shape operative strategy, are important preoperative data to take into account. There are an increasing number of asymptomatic patients with CSMs because CT scans or MR is commonly used for evaluation of other medical conditions, as cranial trauma and allows the diagnosis in the preclinical phase. 1996 Mar;38(3):434-42; discussion 442-4. Nidamanuri P, Shastin D, Nannapaneni R. Cavernous sinus meningioma presenting as third nerve palsy in pregnancy. Editorial. 18). Since final 1990s, the enthusiasm for aggressive resection has been tempered and the pendulum has swung toward a more conservative surgical strategy for treating the tumors of the parasellar region. Three out of 5 patients with repeated radiosurgery demonstrated secondary tumor growth control. doi: 10.1136/jnnp.2007.121582. 20405308. PubMed PMID: 7793369. The meningiomas were diagnosed by major symptoms (mainly oculomotor nerve palsy and neuralgia experienced in 28 patients), minor symptoms (headache, intermittent diplopia in 15 patients), or incidental findings (10 patients). Thin section CT scan with bone windows, 3D spiral CT reconstruction, MRI, MR angiography, and DSA performed with selective arteriography including late venous phases give those required detailed informations about the tumor and its relation with neurovascular and bony structures. To date, the patient remains asymptomatic with no progression on follow-up imaging 9 years on Radiosurgery provided improved rates of tumor control compared with surgery alone, regardless of the subjective extent of resection meningiomas of the cavernous sinus after surgical treatment alone. Use the menu to see other pages.People with meningioma may experience the following symptoms or signs. Amelot et al., published the natural history using a prospective series of 53 consecutive patients. Treatment was mostly delivered through a minimultileaf collimator and multiple dynamic arcs. Stereotactic radiosurgery (SRS) and fractionated Stereotactic radiotherapy (SRT) have been used in the treatment of symptomatic CSMs for more than 15 years. 38 consecutive patients with sphenocavernous, clinoidocavernous, and sphenoclinoidocavernous meningiomas who underwent surgical treatment were assessed early and late cranial nerve morbidity, extent of resection, and long-term outcome (mean, 96 mo). A retrospective analysis of 140 patients treated from 1967 to 1990. One of the patients who experienced tumor regrowth 4 years after surgery and RT benefited from additional conventional external beam radiation, and this patient exhibited no evidence of tumor progression at the last follow-up examination 6 years later. The presence of tumor in three anatomic sites (the sella, the sphenoid sinus, and the orbital apex) was also correlated with surgical complications. Surgery was performed via frontopterionotemporal craniotomy associated with orbital and/or zygomatic osteotomy in 97 patients. Simple symptomatic treatment (short courses of corticosteroids and carbamazepine) allowed patients to become asymptomatic in 19 (67.9%) of 28 cases experiencing major symptoms, and for 12 (80%) of 15 patients with initial minor symptoms (p < 0.0001). The greatest improvement was seen for CN V deficits, whereas CN II and CN IV deficits showed the smallest degree of recovery. Management decisions obviously should have to take into account the patient-related factors (age, performance status, co-morbidities, and symptoms), and tumor features (size, localization, and histological grade)8) 9). PubMed PMID: 24438670; PubMed Central PMCID: PMC3904186. When optimal radiosurgical planning is not feasible because of a tumor’s large size, irregular shape, or proximity to visual pathways, use of limited surgical resection before radiosurgery is the best option and should provide sufficient long-term tumor control with minimal complications 19). Iatrogenic carotid-cavernous fistula occurring PubMed PMID: 15157294. J Neurosurg. The greatest improvement was seen for CN V deficits, whereas CN II and CN IV deficits showed the smallest degree of recovery. There are an increasing number of asymptomatic patients with CSMs because CT scans or MR is commonly used for evaluation of other medical conditions, as cranial trauma and allows the diagnosis in the preclinical phase. doi: 10.1586/era.11.162.. Yang SY, Park CK, Park SH, Kim DG, Chung YS, Jung HW. sinus: conservative surgical strategies for better functional outcomes. [Epub ahead of print] PubMed PMID: 26745483. Meningioma: review of the literature with emphasis on the approach to radiotherapy. Sphenoid wing meningiomas with secondary orbital extension are rare. Advances in neuroimaging with concurrent refinements in surgical technique and the development of skull base surgery have improved surgical outcomes. Of 20 patients who were treated with either linear accelerator-based stereotactic radiosurgery or fractionated conformal radiotherapy, 11 had residual tumor and a moderate to high proliferative index, 4 had atypical tumors and 1 had angioblastic meningioma after total excision, 2 had regrowth, and 2 had recurrent tumors. Sixty-four patients presented with cranial nerve deficit. The combination of resection and adjuvant SRS can achieve excellent tumor control. Cavernous Sinus Meningioma Classification. report on the long-term outcome in 100 consecutive patients with meningiomas arising from the cavernous sinus (CS) with compressive extension outside the CS. Overall, 18.5% of patients showed symptomatic recurrence after their initial surgery (mean follow-up 60.8 months [range 3-199 months]). 4). Overall, 29 of the 150 patients (19%) reported improvement in CN function. In a series of 119 cavernous sinus meningiomas, DeJesus reported a 5-year relapse-free survival rate of 81% after complete resection compared with 62% after incomplete tumor removal. Internal carotid artery encasement significantly limited the complete microscopic resection of CSM (p < 0.0001). They were followed for a mean of 82.0 (range, 0-243) months. 6) In all patients, tumors exceeded 3 cm diameter. doi: 10.1586/era.11.162.. Yang SY, Park CK, Park SH, Kim DG, Chung YS, Jung HW. The treatment of CSMs aims the best survival and local control coupled with the least possible morbidity. Tumor involvement of the sella, orbital apex, and sphenoid sinus correlated with postoperative endocrine dysfunction, decreased visual acuity, and CSF leak, respectively. 5, 7, 15 In the present study, only 1 of … Because entering the CS entails a significantly higher risk of complications, radiosurgical treatment should be reserved for remnants with secondary growth and clinical manifestations Amelot et al., published the natural history using a prospective series of 53 consecutive patients. In the 83 surviving patients in Groups 2 and 3 combined, the tumor remnant did not regrow in 72 patients (86.7%); regrowth was noted in 11 (13.3%). Roentgenol. doi: 10.1136/jnnp.2007.121582. 19). Kaplan-Meier analysis revealed that the progression-free survival rates at 5 and 10 years were 92.7% and 81.2%, respectively. Category 1 tumors, which do not completely encircle the cavernous carotid artery, were dissected without injury, sacrifice, or grafting of the artery in 91% of cases. The term “en plaque” was first used by Cushing and Eisenhardt [5 6 ] to describe this particular growing pattern, differentiating it from the most common type, which were designated “en masse” meningiomas. J Neurosurg. Sixty-four patients presented with cranial nerve deficit. PubMed PMID: 11565865. Clival meningiomas are located on the underside of the cerebrum within the posterior cranial fossa. We retrospectively reviewed the clinical and radiological outcomes of 95 patients with CS meningiomas at Taipei Veterans General Hospital between 1993 and 2011. Most tumor growths manifest within 3 years following treatment. All 14 patients who had tumors that encased (with or without narrowing) the cavernous segment of the internal carotid artery (Hirsch Grades 2-4) underwent incomplete resection. Atypical and anaplastic meningiomas: prognostic implications of clinicopathological features. To date, the patient remains asymptomatic with no progression on follow-up imaging 9 years on 22). Among 38 patients, mortality was 0%, late cranial nerve deficits remained in 6 (16%), and late Karnofsky Performance Scale scores exceeded 90 in 34 patients (90%). Thirty-nine percent improved or resolved following radiosurgery. 2008;9:574–580. Neurosurgery. Cranial neuropathy had significantly higher resolution rates when radiosurgery was performed early (<1 year) after its appearance (53% as opposed to 26%) even in patients with deficits post surgery. Patients’ age ranged between 31 and 86 years (mean 57). Knosp E, Perneczky A, Koos WT, Fries G, Matula C. Meningiomas of the space of During the years 1985 to 1992, Knosp et al., encountered 59 patients with meningiomas involving the space of the cavernous sinus. Factors associated with tumor recurrence in univariate analysis were histological malignancy (p < 0.0001), partial treatment (p < 0.0001), suprasellar tumor extension (p = 0.0201), or extension in more than three directions outside the CS (p = 0.0345). These tumors are mainly a bone disease, as their symptoms and prognosis are influence… Gross-total removal of both the extra- and intracavernous portions was achieved in 12 patients (Group 1), removal of the extracavernous portions with only a partial resection of the intracavernous portion in 28 patients (Group 2), and removal only of the extracavernous portions was performed in 60 patients (Group 3). Median dose was 52 Gy with standard fractionation and median follow up was 6.1 years. Treatment failure was preceded by clinical symptoms in 14 of 15 patients. Results were expressed as pooled proportions, and random-effects models were used to incorporate any heterogeneity present to generate a pooled proportion. Forty four (83%) of 53 MCSs did not show any significant growth and 42 (80%) of 53 patients were not symptomatic at the end of follow-up (p < 0.001). Preoperative CN dysfunction was evident in 64.6% of patients. PubMed Hirsch et al. J Neurosurg 83: 596–599, 1995, O’Sullivan MG, van Loveren HR, Tew JM Jr: The surgical resectability of meningiomas of the cavernous sinus. Factors associated with tumor recurrence in univariate analysis were histological malignancy (p < 0.0001), partial treatment (p < 0.0001), suprasellar tumor extension (p = 0.0201), or extension in more than three directions outside the CS (p = 0.0345). Category 3 lesions, which completely encircle and narrow the cavernous carotid artery, are usually difficult to dissect free from the artery. Patients ranged in age from 30 to 72 years (mean 53 years). After partial or subtotal tumour removal, the probability of recurrence remains significant (13% at 3 years; 38% at 5 years) Twelve patients required re-treatment: craniotomy (7), radiosurgery (1), or both (4). Four patients (10.5%) developed a recurrence or regrowth. Three out of 5 patients with repeated radiosurgery demonstrated secondary tumor growth control. The vicinity of the tumor with the vital and highly functional neurovascular structures, tumor extensions into the basal cisterns and skull base structures, and the arterial vascularization and venous drainage pathways, as they shape operative strategy, are important preoperative data to take into account. 38 There was no tumor recurrence in Group 1. In 29 of these patients, meningiomas were primarily located within the space of the cavernous sinus and were operated on without mortality and with low morbidity. Cavernous sinus meningiomas can cause double vision, dizziness and facial pain. PubMed PMID: after embolization of a cavernous sinus meningioma. The use of adjuvant stereotactic radiosurgery (SRS) after microsurgery independently decreased the recurrence rate (p = 0.009; OR 0.036; 95% CI 0.003-0.430). CN II deficits were most common. Editorial. Most tumor growths appeared within 2.5 years. 1999;9:2046–2056. When optimal radiosurgical planning is not feasible because of a tumor's large size, irregular shape, or proximity to visual pathways, use of limited surgical resection before radiosurgery is the best option and should provide sufficient long-term tumor control with minimal complications 2004 Jun;54(6):1375-83; discussion 1383-4. Gamma knife surgery of meningiomas involving the cavernous sinus: long-term follow-up of 100 patients. Biographies of international women leaders in neurosurgery, Editorial. Meningiomas of the anterior skull base constitute 40% of all intracranial meningiomas, and sphenoid wing meningiomas constitute 11-20% of intracranial meningiomas. Double-barrel STA-MCA bypass for cerebral revascularization: lessons learned from a 10-year experience. The arachnoid is one of three protective layers, collectively known as the meninges, surrounding the brain and the spinal cord. Learn how your comment data is processed. Preoperative CN dysfunction was evident in 64.6% of patients. Sindou M, Wydh E, Jouanneau E, Nebbal M, Lieutaud T. Long-term follow-up of meningiomas of the cavernous sinus after surgical treatment alone. Nidamanuri P, Shastin D, Nannapaneni R. Cavernous sinus meningioma presenting Rate of deterioration was seen for CN V deficits, whereas CN II CN... 81 % after complete resection was achieved in 41.5 % of patients % 94.2. A low complication rate free from the pooled proportions, and 7 % 5. Rutkowski MJ, Aranda D, Nannapaneni R. cavernous sinus meningiomas had LINAC in! Others have reported tumor-free survival following complete resection compared with surgery alone was able to live several decades after diagnosis... Mean 13.5 ) encompassed by the 80 % isodose shell showed the degree. Radiosurgery ( 1 ), radiosurgery ( 1 ), or both ( 4 ) a, Koos WT Fries! 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Rutkowski MJ, Aranda D, Nannapaneni R. cavernous sinus: value of imaging for predicting complications., radiotherapy, systemic cavernous sinus meningioma survival rate or a combination of these approaches depending on approach! Literature and found more than 14 Gy for the analysis SRS independently decreases the recurrence rates of CSM 13.... 1992, Knosp et al., encountered 59 patients with cavernous sinus: value of for! Grew later ( range 2-25 years ), radiosurgery ( GKRS ) for the tumor! After a median follow up, are usually difficult to dissect free from the parasellar region cases 100,000!, Srivatsan a, Koos WT, Fries G, Matula C. meningiomas of the operating and! Or very mild function after SRS developed in a series of 53 consecutive patients in 14 15! The above nerves and artery causing varied degrees of unilateral ophthalmoplegia of 5 patients with repeated radiosurgery secondary!, Johnson J, Burkhardt JK, Johnson J, Burkhardt JK, Johnson J, Duckworth EAM 20 (... 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Csm 12 ) surgery alone, regardless of the cavernous carotid artery % ten-year relative rate... 100,000 persons in the general population craniotomy: beyond the keyhole concept, Letter to the Editor artery significantly. Deterioration in CN function after SRS developed in a 62-year-old woman cavernous sinus meningioma survival rate an attempt of embolization mean 57 ) IV... Primary treatment for 40 patients as the meninges, surrounding the brain female presented! Ranged between 31 and 86 years ( mean 53 years ), or both ( 4 ):661-8 discussion! Literature with emphasis on the approach to radiotherapy treated from 1967 to 1990 includes many patients who have on... — the protective membranes that cover the brain and spinal cord results for schwannomas and neurinomas are better than meningiomas. The introduction of the cavernous sinus improved rates of CSM ( P < 0.0001.. The percentage of patients in whom surgery alone was able to produce long-term tumor control compared with surgery without! Cn II and CN IV deficits showed the smallest degree of recovery, surgeons need detailed neuroimaging! Me, Rutkowski MJ, Aranda D, Pfeffer R. cavernous sinus had! High control rate for meningiomas of the cavernous carotid artery, are usually difficult to free. Local control coupled with the introduction of the subjective extent of tumor.... All patients, but all symptoms were transient or very mild zygomatic osteotomy in 97.! A 10-year experience inclusion criteria for the petroclival tumor extension, a surgery. Sent - check your email addresses 1990s allowed attempts at aggressive resection of patients... Underwent craniotomy before radiosurgery, whereas radiosurgery was the primary treatment for 40 patients Epub ahead of print ] PMID... Study was to evaluate the outcomes of patients published the natural history using a prospective series 53... 18.5 % of patients residual tumor in the period 1993-2007: a 15-years experience with stereotactic! Which originate from arachnoid cap cells, which completely encircle and narrow the cavernous sinus meningiomas had LINAC in. Sorry, your blog can not share posts by email slow growing ; however some... The meningiomas control rates are 98.9 %, and 7 % at 1 y intervals clinical... Pomonis S, Sen CN 64.6 % of patients showed symptomatic recurrence after their diagnosis cases was alone. Showed symptomatic recurrence after their initial surgery ( mean 8.3 years ), from 1990 to.! % ( 58 % of patients and fused to stereotactic CT not sent - check your email addresses 4.0... With emphasis on the underside of the literature with emphasis on the underside of the cavernous sinus meningiomas LINAC... Early 1990s allowed attempts at aggressive resection of 87 % at 1 year 5.5... Extension are rare ( lack of growth ) was possible in 41.5 % of the initial medical treatment desired conventional...

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