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Gamma knife surgery of meningiomas involving the cavernous sinus: long-term follow-up of 100 patients.

https://arctichealth.org/en/permalink/ahliterature97633
Source
Neurosurgery. 2010 Apr;66(4):661-8; discussion 668-9
Publication Type
Article
Date
Apr-2010
Author
Bente Sandvei Skeie
P O Enger
G O Skeie
F. Thorsen
P-H Pedersen
Author Affiliation
Department of Neurosurgery, Haukeland University Hospital, N-5021 Bergen, Norway. bsai@helse-bergen.no
Source
Neurosurgery. 2010 Apr;66(4):661-8; discussion 668-9
Date
Apr-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Cavernous Sinus - surgery
Female
Humans
Longitudinal Studies
Male
Meningeal Neoplasms - pathology - surgery
Meningioma - pathology - surgery
Middle Aged
Radiosurgery - methods
Retrospective Studies
Time Factors
Treatment Outcome
Young Adult
Abstract
OBJECTIVE: Resection of meningiomas involving the cavernous sinus often is incomplete and associated with considerable morbidity. As a result, an increasing number of patients with such tumors have been treated with gamma knife surgery (GKS). However, few studies have investigated the long-term outcome for this group of patients. METHODS: 100 patients (23 male/77 female) with meningiomas involving the cavernous sinus received GKS at the Department of Neurosurgery at Haukeland University Hospital, Bergen, Norway, between November 1988 and July 2006. They were followed for a mean of 82.0 (range, 0-243) months. Only 2 patients were lost to long-term follow-up. Sixty patients underwent craniotomy before radiosurgery, whereas radiosurgery was the primary treatment for 40 patients. RESULTS: Tumor growth control was achieved in 84.0% of patients. Twelve patients required re-treatment: craniotomy (7), radiosurgery (1), or both (4). Three out of 5 patients with repeated radiosurgery demonstrated secondary tumor growth control. Excluding atypical meningiomas, the growth control rate was 90.4%. The 1-, 5-, and 10-year actuarial tumor growth control rates are 98.9%, 94.2%, and 91.6%, respectively. Treatment failure was preceded by clinical symptoms in 14 of 15 patients. Most tumor growths appeared within 2.5 years. Only one third grew later (range, 6-20 yr). The complication rate was 6.0%: optic neuropathy (2), pituitary dysfunction (3), worsening of diplopia (1), and radiation edema (1). Mortality was 0. At last follow-up, 88.0% were able to live independent lives. CONCLUSION: GKS gives long-term growth control and has a low complication rate. Most tumor growths manifest within 3 years following treatment. However, some appear late, emphasizing the need for long-term follow-up.
PubMed ID
20305491 View in PubMed
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Spontaneous isolated dural arteriovenous fistula of the cavernous sinus: endovascular approach via the foramen ovale. A technical note.

https://arctichealth.org/en/permalink/ahliterature118348
Source
Interv Neuroradiol. 2012 Dec;18(4):458-62
Publication Type
Article
Date
Dec-2012
Author
G. Cabral De Andrade
H P Alves
R. Parente
C P Salvarani
V M Clímaco
E R Pereira
Author Affiliation
Centro Integrado de Neurologia e Neurocirurgia, Maringá, Brazil. g.c.andrade@hotmail.com
Source
Interv Neuroradiol. 2012 Dec;18(4):458-62
Date
Dec-2012
Language
English
Publication Type
Article
Keywords
Aged
Cavernous Sinus - surgery
Central Nervous System Vascular Malformations - surgery
Cerebral Veins - surgery
Endovascular Procedures - methods
Female
Humans
Hyperemia - surgery
Neurosurgical Procedures - methods
Abstract
The endovascular treatment of spontaneous dural cavernous sinus fistula (DAVF) can be accomplished by arterial approach, just with symptoms relief, or by numerous venous approaches through the inferior petrosal sinus, ophthalmic vein, anterior or posterior intercavernous sinus and facial vein. Our case suggests the approach to the cavernous sinus via the foramen ovale and emissary veins puncture as an alternative when there is no possibility of venous approach conventionally described. A 76-year-old woman presented with right conjunctival hyperemia, exophthalmos, intraocular pressure increasing and visual deficits in a period of six months. Angiographic diagnosis of spontaneous DAVF isolated from the cavernous sinus, Barrow Type C, with exclusive venous drainage through the superior ophthalmic vein. Endovascular treatment was performed under general anesthesia. Attempts to approach the cavernous sinus through the inferior petrosal sinus ipsilateral and contralateral intercavernous, facial vein and pterygoid plexus, as well as by dissection and direct puncture of the superior ophthalmic vein were not possible. An approach to the cavernous sinus was performed by puncturing the foramen ovale, catheterization of the emissary vein of the foramen ovale with occlusion of the fistula with microcoils. There was a symptomatic regression with gradual normalization of intraocular pressure, exophthalmos and conjunctival hyperemia in three months. The approach to the cavernous sinus through the foramen ovale and catheterization of the emissary cranial skull base vein is an exception and should be considered in cases of spontaneous and isolated DAVF not accessible by a conventional approach.
Notes
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PubMed ID
23217641 View in PubMed
Less detail