Background/Objectives: Resection of tumors invading the cavernous sinus (CS) carries a risk of injury to the cranial nerves and internal carotid artery. Therefore, radical surgery involving lesions around the CS remains challenging, especially for lesions invading the CS, optic sheath, and oculomotor cave. Here, we describe a surgical strategy for meningiomas invading these structures and report on the clinical outcomes.Methods: Surgical resection was indicated in patients with neurological symptoms or rapid tumor growth for the restoration of cranial nerve function. We investigated 13 patients who had preoperative images of CS invasion, underwent surgical resection, and were followed-up with magnetic resonance imaging for at least 1 year between July 2017 and July 2024. Their preoperative symptoms, postoperative course, adjuvant therapy, postoperative complications, degree of resection, and recurrence were evaluated.Results: The mean patient age was 59.1 years (range, 23–73 years), and 10 were female. Major preoperative symptoms included oculomotor nerve paresis in 8 patients (61.5%), abducens nerve paresis in 6 (46.2%), visual disturbance in 7 (53.8%), and brain swelling in 3 (23.1%). These symptoms improved at least partially after surgery in 7 (87.5%), 5 (83.3%), 7 (100%), and 3 (100%) patients, respectively. Major postoperative complications included contralateral visual deterioration in 1 patient (7.7%) and brief transient slight hemiparesis caused by internal carotid vasospasm or dissection in 2 (15.4%). Four patients with residual atypical meningioma in the CS underwent intensity-modulated radiotherapy (IMRT). The lesions in 6 patients recurred or regrew, resulting in additional treatment with stereotactic radiosurgery in 2 patients, IMRT in 3, and resection in 1.Conclusions: Our surgical strategy for the surgical resection of meningiomas in and around the CS for the restoration of cranial nerve function is safe and effective, with only transient acceptable injuries. Even if the tumor in the CS is too stiff to be removed, it is important to open the optic nerve sheath and oculomotor cave widely to effectively remove the tumor.
背景/目的：切除侵犯海绵窦的肿瘤存在损伤颅神经及颈内动脉的风险。因此，涉及海绵窦周围病变的根治性手术仍具挑战性，尤其对于侵犯海绵窦、视神经鞘及动眼神经窝的病变。本文旨在描述针对侵犯上述结构的脑膜瘤的手术策略，并报告其临床疗效。 方法：手术切除适用于出现神经症状或肿瘤快速生长、需恢复颅神经功能的患者。本研究纳入了2017年7月至2024年7月期间13例术前影像学证实海绵窦受侵、接受手术切除且术后磁共振随访至少1年的患者。评估指标包括术前症状、术后病程、辅助治疗、术后并发症、切除程度及复发情况。 结果：患者平均年龄59.1岁（范围23-73岁），其中女性10例。主要术前症状包括：动眼神经麻痹8例（61.5%）、外展神经麻痹6例（46.2%）、视力障碍7例（53.8%）及脑水肿3例（23.1%）。术后症状改善情况分别为：动眼神经麻痹7例（87.5%）、外展神经麻痹5例（83.3%）、视力障碍7例（100%）、脑水肿3例（100%）至少获得部分缓解。主要术后并发症包括：对侧视力恶化1例（7.7%），因颈内动脉痉挛或夹层导致短暂性轻度偏瘫2例（15.4%）。4例海绵窦内残留非典型脑膜瘤患者接受了调强放疗。6例患者出现肿瘤复发或再生，其中2例接受立体定向放射外科治疗，3例接受调强放疗，1例再次手术切除。 结论：本研究提出的针对海绵窦及周围脑膜瘤、以恢复颅神经功能为目标的手术策略安全有效，仅出现短暂性可接受的神经损伤。即使海绵窦内肿瘤质地坚硬难以全切，广泛开放视神经鞘及动眼神经窝对有效切除肿瘤至关重要。
Resection of Meningiomas Invading the Cavernous Sinus: Treatment Strategy and Clinical Outcomes
肿瘤(癌症)患者之家