2026 Proffered Presentations
S026: SURGICAL STRATEGY, TECHNIQUE, AND CLINICAL OUTCOME FOR MENINGIOMA IN AND AROUND THE CAVERNOUS SINUS
Takashi Sugawara, MD, PhD; Akira Saitoh, MD; Shuhei Yamasaki, MD; Ryohei Sashida, MD; Tomihiro Wakamiya, MD, PhD; Takashi Agari, MD, PhD; Kazuaki Shimoji, MD, PhD; Eiichi Suehiro, MD, PhD; Keisuke Onoda, MD, PhD; Akira Matsuno, MD, PhD; Department of Neurosurgery, International University of Health and Welfare
Objective: Radical resection of meningioma in and around the cavernous sinus remains challenging due to risk of cranial nerves and carotid artery injury. This presentation shows surgical strategies and techniques as well as the clinical outcome for meningioma in and around cavernous sinus with intraoperative video.
Materials and Methods: Surgical resection is indicated for patients with neurological symptoms. The temporal dura propria is peeled from the lateral wall of the cavernous sinus and the anterior clinoid process is removed. Once the cranial nerves III, IV and V(1-3) have been identified in the lateral wall of the cavernous sinus, the Parkinson triangle (b/w CN.IV and V1) and the paramedial triangle (b/w CN.III and IV) are opened and then tumor is resected. If the internal carotid artery is narrowing, maneuvers near this artery are avoided to prevent injury.As much of the lesion in the cavernous sinus as possible is removed while preserving the cranial nerves. The tumor in the cavernous sinus is left if the tumor is deemed too firm to be removed without causing permanent damage to the cranial nerves. If the patient has neurological symptoms such as diplopia, ptosis or visual field disturbance, the optic sheath and the oculomotor cave are opened widely. Lesions within the optic sheath, the oculomotor cave and around the Dorello’s canal are then resected in order to decompress the cranial nerves and restore their function.
The preoperative symptoms and their postoperative course of 20 surgically resected meningiomas which were followed for more than one year postoperatively, were evaluated, with a particular focus on oculomotor, abducens, optic nerve function.
Results: Tumor resection was performed with the aim of restoring the function of oculomotor, abducens, and optic nerve in 13, 11, and 6 patients respectively. And this functional recovery was achieved completely in 8(62%), 6(55%), and 2(33%) patients and partially in 2(15%), 2(18%), and 4(67%) patients respectively (complete or partial recovery in 10(77%), 8(73%), 6(100%) patients). The function of these cranial nerves was not restored in 3 patients. One of these cases was recurrent case following resection and SRS therapy, and 2 of these cases were the cases of long-term persistence of symptoms (8,11 months). Postoperative complications were brief transient hemiparesis by IC dissection or vasospasm in 2 cases. Four residual WHO grade II meningiomas in cavernous sinus underwent IMRT after resection. Seven meningiomas (4 recurrent WHO grade 2 and 3 WHO grade 1 meningioma) recurred or regrew and underwent IMRT orγknife radiosurgery.
Conclusion: In surgical resection of meningioma in and around the cavernous sinus to restore the cranial nerve function, functional recovery was accomplished at a higher rate. However, restoring cranial nerve function through surgical resection may be difficult for patients who have undergone radiation therapy or experienced long-term persistence of symptoms. Most of these tumors can be effectively controlled with only acceptable transient insult by careful and delicate procedures.