August 04, 2015
Let's review resection of a large cavernous sinus meningioma. This is the case of a 54 year-old female who presented with facial numbness. On the right side, MRI evaluation revealed a large, relatively, heterogeneously-enhancing mass within the cavernous sinus, suspected to be a schwannoma or a meningioma. A right frontotemporal craniotomy was completed. Right temporal lobe, right frontal lobe. The tumor is located just along the anterior aspect and inferior aspect of the temporal lobe covered by the lateral wall of the cavernous sinus. An incision was made within the lateral wall of the cavernous sinus to expose the tumor capsule. Here's the incision within the inferior part of the tumor, floor of the middle fossa. The tumor was relatively fibrous and a pituitary rongeur was used to aggressively debulk the tumor. Here's the lateral wall of the cavernous sinus against the surface of the tumor. This dissection plane was followed circumferentially. You can see the branches of the trigeminal nerve. The tumor was gently dissected away from these nerves. Sphenoid wing. This tumor is relatively large and additional incisions within the lateral wall of the cavernous sinus are necessary to adequately expose the tumor. Additional incision was created and tumor debulking continues until venous bleeding from the live portion of the cavernous sinus was encountered. Here is another dissection plane between the capsule of the tumor and dura. Obviously, the nerves along the lateral wall of the cavernous sinus should be carefully protected. Here, you can see some venous bleeding from the live part of the sinus. More tumor debulking continues. Gel foam was used to seal the bleeding from the live portion of the cavernous sinus. More tumor debulking continued more posteriorly. You can see the adherence of some of the MCA branches to the elevated dura of the cavernous sinus. I also investigated the entry point of the cranial nerves into the cavernous sinus. These nerves are all medial to the trigeminal nerves that were decompressed. Here's the entry point of the third nerve. Postoperative CT scan demonstrated good resection of the tumor and this patient recovered from her surgery uneventfully. Thank you.
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