gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Minimal invasive approach to cavernous and juxtaclival tumours in elderly patients – Preliminary results

Minimal invasiver Zugang zu Tumoren des Sinus cavernosus oder der juxtaclivalen Region bei älteren Patienten - vorläufige Ergebnisse

Meeting Abstract

Suche in Medline nach

  • corresponding author Friederike Knerlich - Neurochirurgische Universitätsklinik, Robert-Koch-Str. 40, 37075 Göttingen
  • R. Verheggen - Neurochirurgische Universitätsklinik, Robert-Koch-Str. 40, 37075 Göttingen
  • M. Buchfelder - Neurochirurgische Universitätsklinik, Robert-Koch-Str. 40, 37075 Göttingen

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocMI.02.08

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter:

Veröffentlicht: 23. April 2004

© 2004 Knerlich et al.
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The optimal management of patients with cavernous sinus or juxtaclival tumours present a unique challenge in surgical treatment and remains controversial, especially in elderly patients. Due to several reasons (age, co-morbidity, senescence, vasculopathy) a special subgroup of patients may profit from an alternative minimal invasive approach to the cavernous sinus or the juxtaclival area by a transsphenoidal access.


In the last 18 months, 9 patients (age ranging from 65-82 years) with the radiological diagnosis of a tumour mass of either of the cavernous sinus, clivus or the juxtaclival region underwent surgery. Deterioration of visual acuity, diplopia, oculomotor nerve palsy, severe cephal gia, pain and hypaesthesia in the trigeminal nerve distribution were the leading complaints. Due to age, reduced general condition and preceding neurosurgical interventions, a transsphenoidal approach was chosen to reduce the tumour mass. Special interest was focussed upon the extent of tumour resection, cranial nerve function and general morbidity. The radiological diagnosis included high resolution MRI with angio-sequences; a conventional angiography was performed in patients with preceding surgical interventions to exclude coexisting vascular pathologies.


In all patients with a partial tumour resection, either a consolidation or improvement of visual acuity or oculomotor function was achieved after surgery. In none of the patients were new cranial nerve deficits confirmed. Intraoperative technical difficulties were dependent on tumour consistency, vascularity, vascular and cranial nerve incasement and the destruction of the skull base. The average operation time was less than 120 min. In none of the cases were blood transfusions necessary, and likewise, re-operations due to CSF leakage were not required.


To summarise, the transsphenoidal approach is ideal in elderly patients with reduced general conditions (ASA > III) leading to a significant tumour reduction. Even in cases with former neurosurgical interventions this access seem to be safe, facilitating a decompression of cranial nerves and preserving visual acuity. The cardinal medical argument for this procedure is the chance to increase the quality of life, regain patient autonomy and thus to ameliorate quality of life.