Artikel
MRI aspect of cavernous sinus meningiomas and its role for the treatment strategy
Suche in Medline nach
Autoren
-
S. Froelich
- Service de Neurochirurgie, CHU de Hautepierre, Strasbourg
-
Eid M. Abu
- Service de Radiologie, CHU de Hautepierre, Strasbourg
-
J. Mourtada
- Service de Neurochirurgie, CHU de Hautepierre, Strasbourg
-
P. Kehrli
- Service de Neurochirurgie, CHU de Hautepierre, Strasbourg
-
J. L. Dietemann
- Service de Radiologie, CHU de Hautepierre, Strasbourg
-
D. Maitrot
- Service de Neurochirurgie, CHU de Hautepierre, Strasbourg
| Veröffentlicht: | 4. Mai 2005 |
|---|
Gliederung
Text
Objective
Since radiosurgery has been widely approved for the treatment of cavernous sinus meningiomas, the actual treatment strategy may include microsurgery for a significant and/or symptomatic extracavernous part of the tumor and radiosurgery for the remaining tumor into and around the cavernous sinus. Considering the recent advances of MRI, the goal of this study was to analyze the spreading and aspect of cavernous sinus meningiomas, in order to improve the indications and the treatment modalities of microsurgery and radiosurgery.
Methods
The MRI scans of 70 meningiomas of the cavernous sinus were retrospectively reviewed. All patients had at least an MRI scan after 1993, including sagittal, coronal and axial T1 without and with contrast enhancement, proton density, T2 and inversion recovery images as well as an Angio-MR. The temporal, supra-sellar, sellar, orbital, sphenoidal, pterygopalatin, infratemporal, petrosal and petroclival extensions, the internal carotid artery, the extent of hyperostosis and the aspect of the lateral wall of the cavernous sinus were studied.
Results
An infiltration of the superior orbital fissure and the posterior orbit was observed in 33% and 13% of cases respectively. The infratemporal and pterygopalatin fossa, below the foramen rotundum and foramen ovale, were infiltrated in 18% and 27% of cases respectively. The sella turcica was invaded in 52% of cases with an infiltration and/or a dislocation of the pituitary gland. The sphenoid sinus was invaded in 46% of cases. The Meckle's cave was invaded in 52% of cases and a petroclival extension was observed in 30% of cases, with a mass effect on the brain stem in 18% of cases. The lateral wall was clearly distinguished from the tumor in 82% of cases.
Conclusions
The identification of the lateral wall of the cavernous sinus into the meningioma allows a clear assessment of the extracavernous tumor volume and enables to predict the benefit of microsurgery in term of tumor reduction. The identification of the exact extent of the tumor enables to conform, more precisely, the irradiation field to the tumor volume. The infiltration of orbit beyond the superior orbital fissure, identified using T1 post-gadolinium weighted images with fat saturation, is rare and overestimated in the literature. The infratemporal and pterygopalatin fossa extension is underestimated and may be an important factor for tumor regrowth.
