PubMed · 16936376
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Manu Kothari, Atul Goel. 2006. Ocularizing the cavernous sinus: a teleologic tale.. https://doi.org/10.4103/0028-3886.27140
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The microanatomy of the superior orbital fissure (SOF) was studied in 96 sides of cadaver specimens. The SOF is a narrow bony cleft that lies at the apex of the orbit between the greater and lesser wings of the sphenoid. Through this fissure, many important structures enter the orbit from the middle cranial fossa including the third, fourth, sixth cranial nerves, and the ophthalmic branch of the fifth nerve. In addition, the superior opthalmamic vein exits the orbit to drain into the cavernous sinus via the SOF. The fissure can be divided into three anatomical regions by the annulus of Zinn (common annular tendon): the lateral, central, and inferior regions. The lateral wall of the SOF can also be divided between the upper and lower segments, and the angle between them was measured to be 144.27 degrees +/- 20.03 degrees . Defining these regions is useful in describing the course and placement of the nerves and vasculature in the SOF. Managing lesions at the orbital apex requires an extensive knowledge of the cranial base and the intracranial and extracranial relationships of the anatomical structures coursing through the SOF. The goal of this study was to describe the microanatomy of the SOF region in detail and to provide a reference for surgical procedures involving the orbital apex.
BACKGROUND AND PURPOSE: Capillary hemangioma of the cavernous sinus is a rare benign skull base tumor that can successfully be treated with radiotherapy. Due to its location, both the tumor itself and the treatment might cause significant functional deficits. Therefore, the different treatment options should be discussed with the patients. CASE REPORT: A case of successful stereotactic fractionated radiotherapy (SFRT) performed after multiple recurrences is described. A 62-year-old male patient with a hemangioma of the right cavernous sinus, orbita and suprasellar region who had previously undergone three surgical procedures received postoperative SFRT for the residual tumor (target volume 85 cm3, Figure 1). SFRT was administered 5 months after surgery with single daily fractions of 2 Gy to a total dose of 40 Gy. RESULTS: No acute or late toxicity of SFRT was observed. Symptomatic improvement was evident 6 months after SFRT. Imaging over a 20-month period showed a continuous and pronounced decrease in residual tumor size (Figure 2). CONCLUSION: Postoperative SFRT with moderate doses is well tolerated and might induce both symptomatic and radiologic improvement of large capillary hemangioma.
PURPOSE: To analyze own long-term results with fractionated stereotactic radiotherapy (FSRT) in patients with benign meningiomas of the cavernous sinus and to review the literature on these rare lesions. PATIENTS AND METHODS: 57 patients were treated with FSRT for benign meningiomas of the cavernous sinus between 01/1990 and 12/2003 at the authors' institution. Histology was WHO grade I in 28/57 lesions, and undetermined in 29/57 lesions. 29 patients received radiotherapy as primary treatment, ten following surgery, and 18 patients were irradiated for recurrent disease. Median target volume was 35.2 cm3. Median total dose was 57.6 Gy with 1.8 Gy per fraction. 51/57 patients showed clinical symptoms before radiotherapy like reduced vision (n = 19), diplopia (n = 25), or trigeminal hyp-/dysesthesia (n = 17). RESULTS: Median follow-up period was 6.5 years. 50/57 patients were followed for > 36 months. Overall local tumor control was 100%. 39/57 patients had stable disease based on CT/MRI, while 18/57 had a partial remission of tumor volume. Overall survival for patients with WHO grade I meningiomas was 95.5% after 5 and 10 years. Two patients died 2.8 and 4.1 years after radiotherapy due to cardiac failure. In 11/57 patients, preexisting neurologic deficits improved. There was one patient with recurrent hyperlacrimation of one eye on the side of the irradiated meningioma. Three patients complained about subjective visual deterioration after FSRT without any objective findings in an ophthalmologic examination. No late toxicity RTOG >/= degrees III was seen. CONCLUSION: These data demonstrate that FSRT is an effective and safe treatment modality for local control of benign cavernous sinus meningiomas with a minimal risk of significant late toxicity.