gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Effect of surgical decompression of the oculomotor nerve in skull base tumors involving the cavernous sinus

Meeting Abstract

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  • M. Nakamura - Neurochirurgische Klinik, Medizinische Hochschule Hannover, Hannover, Deutschland
  • J.K. Krauss - Neurochirurgische Klinik, Medizinische Hochschule Hannover, Hannover, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocDI.06.04

DOI: 10.3205/11dgnc137, URN: urn:nbn:de:0183-11dgnc1373

Published: April 28, 2011

© 2011 Nakamura et al.
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Outline

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Objective: Skull base tumors involving the parasellar region and cavernous sinus often lead to clinically relevant compression of the oculomotor nerve in their cisternal or intracavernous course. Radical surgical removal of these tumors in the cavernous sinus, especially meningiomas, may be associated with a high rate of irreversible cranial nerve deficits. In patients presenting with oculomotor nerve paresis, the effect of partial surgical decompression of the oculomotor nerve at the entrance into the cavernous sinus has not been systematically evaluated so far. We report on a series of 16 patients with 17 surgical procedures, where the effect of oculomotor nerve decompression at this site was analyzed.

Methods: All patients were operated through the pterional approach using microsurgical technique between April 2005 and April 2010. Surgical decompression of the oculomotor nerve at the entrance into the cavernous sinus was performed including opening of the dura at the entry point in all cases. Clinical data were collected prospectively including preoperative medical history, radiological, operative and histological findings and follow-up records.

Results: Our series includes 10 women and 6 men with a mean age of 55,4 years (40–76 years). There were 13 meningiomas, 1 chondrosarcoma, 1 metastasis and 1 recurrent anaplastic astrocytoma. All patients presented with partial or complete oculomotor nerve palsy before surgery. Tumor compression of the oculomotor nerve at the entrance into the cavernous sinus was observed in all cases. In 2 cases the oculomotor nerve was infiltrated by the tumor. Partial tumor removal was performed in 14 tumors, a subtotal resection in 2 and total resection in 1 patient. Partial or complete functional recovery of the oculomotor nerve was observed in 12 out of 17 procedures (70.6%). The mean follow-up time was 19,8 months (3–60 months). In one patient with a chondrosarcoma, second surgery for oculomotor nerve decompression was performed 23 months after the first surgery.

Conclusions: The majority of patients with skull base tumors compressing the oculomotor nerve in the interpeduncular cistern and entry into the cavernous sinus benefit from surgical decompression except in those cases, where the nerve itself is infiltrated by the tumor. Additional dural incision at the entry into cavernous sinus may provide further space and reduce the compressive effect of the tumor.