MENINGIOMAS DEL SENO CAVERNOSO CEREBRAL.pptx

meningiomas del seno cavernoso

1. CAVERNOUS SINUS MENINGIOMAS Cavernous sinus meningiomas have an estimated incidence of only 0.5 per 100,000. 1 Meningiomas may involve the cavernous sinus either primarily or secondarily. Those originating from within the cavernous sinus proper may extend to the Meckel cave, medially to the sella , and to the anterior, middle, or infratemporal fossae. Clinoidal , medial sphenoid wing, and petroclival meningiomas may extend to the cavernous sinus secondarily.

2. Patients with tumors in the cavernous sinus may present with symptoms referable to compression or congestion of anatomical structures in or near the cavernous sinus. Scarring from prior surgery or cranial radiation may compromise the integrity of the carotid arterial wall and increase the risk of carotid injury during surgery. Ascertaining any possible systemic disease is important for surgical decision making because other cancers, such as lymphoma, breast carcinoma, and paranasal sinus cancers, may metastasize to the dura and mimic meningioma. 6,7 In a retrospective review of 40 patients with skull base meningiomas observed for a mean period of 7 years, 27% of patients worsened clinically, 12 similar to a separate series of 24 patients followed for a mean of 57 months in which 25% worsened neurologically. 13

3. MRA generally reveals the intracranial circulation without the risks of conventional angiography and is important in delineating the caliber of the carotid artery. Conventional angiography with cross-compression should, however, be considered if there is any question about the integrity of the ipsilateral carotid artery or the intracranial circulation in general, or in a patient who has received prior irradiation to the cavernous sinus.