Strategy and technique of endonasal endoscopic bony decompression and selective tumor removal in symptomatic skull base meningiomas of the cavernous sinus and Meckel's cave.

Publication Title

World Neurosurg

Authors

Walavan Sivakumar, Pacific Neuroscience Institute, John Wayne Cancer Institute, Providence Saint John's Health Center, Santa Monica, CaliforniaFollow
Garni Barkhoudarian, John Wayne Cancer Institute Santa Monica, California.Follow
Bjorn M Lobo, Pacific Neuroscience Institute, John Wayne Cancer Institute, Providence Saint John's Health Center, Santa Monica, California
Xin Zhang, Pacific Neuroscience Institute, John Wayne Cancer Institute, Providence Saint John's Health Center, Santa Monica, California
Fan Zhao, Pacific Neuroscience Institute, John Wayne Cancer Institute, Providence Saint John's Health Center, Santa Monica, California
Amy Eisenberg, Pacific Neuroscience Institute, Brain Tumor Center & Pituitary Disorders Program, John Wayne Cancer Institute at Providence Saint John's Health Center, 2200 Santa Monica Blvd., Santa Monica, CA, 90404, USA.Follow
Santosh Kesari, Department of Translational Neuro-Oncology and Neurotherapeutics, John Wayne Cancer Institute at Providence Saint John's Health CenterFollow
Howard Krauss, Pacific Neuroscience Institute, John Wayne Cancer Institute, Providence Saint John's Health Center, Santa Monica, CaliforniaFollow
Pejman Cohan, Pacific Neuroscience Institute, John Wayne Cancer Institute, Providence Saint John's Health Center, Santa Monica, California
Chester Griffiths, Providence St. John's Health Center, Los Angeles, CA, USAFollow
Robert Wollman, Department of Radiation Oncology, Providence Saint John's Health Center, Santa Monica, CA, USAFollow
Lisa Chaiken, Pacific Neuroscience Institute, John Wayne Cancer Institute, Providence Saint John's Health Center, Santa Monica, CaliforniaFollow
Daniel F Kelly, Pacific Neuroscience Institute, Brain Tumor Center & Pituitary Disorders Program, John Wayne Cancer Institute at Providence Saint John's Health Center, 2200 Santa Monica Blvd., Santa Monica, CA, 90404, USA.Follow

Document Type

Article

Publication Date

6-18-2019

Keywords

cranial neuropathy; double vision; endocrinopathy; endonasal approach; endoscopic; meningioma; neurosurgery; tumor

Abstract

BACKGROUND: Parasellar meningiomas involving the cavernous sinus and Meckel's cave pose a management challenge because of invasion around neurovascular structures and the pituitary gland. Management options range from aggressive resection to focused radiotherapy alone. Herein we present a strategy for these tumors of endonasal bony decompression, partial tumor removal, and stereotactic radiotherapy in select cases.

METHODS: Tumor location, prior treatments, cranial neuropathies, pituitary dysfunction, tumor control rates, use of stereotactic radiosurgery (SRS), radiotherapy (SRT) and complications were retrospectively evaluated.

RESULTS: Twenty patients (age range 43-81 years; 65% women; 90% WHO grade I; median follow-up 57 months; 14 without prior debulking and radiation, and 6 with prior debulking and radiation) underwent endonasal bony decompression and partial tumor removal. Most common tumor locations were cavernous sinus (95%), Meckel's cave (95%), sella (75%), petroclival (60%), and optic canal/orbit (30%). Three patients with large meningiomas underwent staged transcranial and endonasal debulking. Of 14 patients without prior debulking and radiation, 11 had postoperative SRT, with tumor shrinkage in 3 (27%). At last follow-up, comparing these 14 patients to the 6 patients with prior surgery and radiotherapy, tumor control was 100% versus 33% (p

CONCLUSIONS: Endonasal bony decompression and selective tumor removal followed by SRT appears to be a reasonable treatment option for most previously untreated parasellar meningiomas. For patients with prior debulking and radiotherapy, new targeted treatment strategies are needed.

Clinical Institute

Neurosciences (Brain & Spine)

Specialty/Research Institute

Neurosciences