What Is a Cavernous Sinus Meningioma?

Cavernous sinus meningiomas (meningiomas of cavernous sinus) refer to meningiomas that originate in or from outside the cavernous sinus.

Basic Information

Visiting department: neurosurgery
Common locations: Cavernous sinus

Common causes: Primary in or from the cavernous sinus
Common symptoms: Forehead and orbital pain on the ipsilateral side of the lesion, oculomotor nerve palsy, exophthalmos, epilepsy

Causes of cavernous sinus meningiomas

Cavernous sinus meningiomas are meningiomas that originate in or from the cavernous sinus.

Clinical manifestations of cavernous sinus meningiomas

It is characterized by forehead and orbital pain, oculomotor nerve palsy, exophthalmos, and epilepsy on the same side of the lesion.

Pain

Pain in the forehead and orbital pain on the ipsilateral side of the lesion is an early symptom, and it progresses to a total headache.

2. Main manifestations of cavernous sinus syndrome

(1) Oculomotor nerve palsy, ocular dyskinesia, ptosis, diplopia and intraocular and dysfunction, dilated pupils, and regulatory reflexes disappear.

(2) The upper oblique and rectus dysfunction are involved in the tackle and abductor nerves .

(3) Numbness of the trigeminal nerve affected face.

3. Epilepsy

It is more common to involve the temporal lobe outward with lesions.

4. Eye lesions

Vision and vision changes.

Cavernous sinus meningiomas

Head CT

A plain scan shows that the cavernous sinus is full, slightly dense, with well-defined masses that are connected to the skull or dura mater by a wide base.

2. Skull MRI (magnetic resonance imaging) plain scan + enhancement

Most are equal or slightly lower T ₁ signals, equal or high T ₂ signals, and obviously uniformly enhanced lesions. The best observation can be obtained with dynamic enhancement in the medium term.

3. DSA (Digital Subtraction Angiography)

Can understand the blood supply artery and embolize the tumor's external carotid artery supply branch before surgery.

4. Head CTA (CT Angiography) / MRA (Magnetic Resonance Angiography)

Can clarify the relationship between tumors and adjacent blood vessels.

5. Neuro-Ophthalmology Examination

Evaluate binocular vision, visual field, extraocular muscle function, and fundus.

Cavernous sinus meningioma diagnosis

Based on the above-mentioned typical clinical manifestations, neuro-ophthalmological findings, and typical neuroimaging, diagnosis is not difficult. The focus should be distinguished from cavernous sinus thrombosis and carotid cavernous sinus that cause cavernous sinus syndrome.

Differential diagnosis of cavernous sinus meningiomas

Cavernous sinus thrombosis

Has a history of infection. Typical clinical manifestations of cavernous sinus syndrome occur within a short period of time. Cerebrospinal fluid examination may have increased white blood cell count, smear or culture can identify pathogenic bacteria. Blood routine leukocytes and neutrophils increased, and erythrocyte sedimentation was rapid. Head CT showed swelling of the cavernous sinus, irregular filling defects, and dilated eye veins. In early MRI, T ₁ WI is equal (high) signal, and T ₂ WI is low (equal) signal. A few days later, it can appear as a signal such as the center and surrounding high signals. ₂ WI high signal, contrast-enhanced T ₁ WI shows filling defects in the cavernous sinus. The direct signs of MRV in the head are high signal loss in normal developing cavernous sinus or low blood flow signals with blurred and irregular edges; indirect signs are venous collateral formation at the obstruction and abnormal expansion of drainage veins in other ways.

2. Carotid cavernous sinus leak

There are many typical symptoms and signs of head trauma, combined membrane edema and congestion, pulsatile exophthalmos, intracranial vascular murmur, and progressive loss of vision at different stages after the injury, which can be diagnosed in combination with cerebral angiography.

3. Olfactory groove meningiomas

Mainly psychiatric symptoms, often euphoria, inattention, unilateral or bilateral loss of smell, and about 30% have major epilepsy. The volume of lesions on MRI is large, and it is mainly in the olfactory sulcus area.

4. Saddle nodule meningioma

The main manifestations are monocular or binocular vision loss, bilateral temporal hemianopia, and optic nerve atrophy. Nipple edema, olfactory sensation, and mental disorders are often ignored. Endocrine disorders may occur, but the saddle is not enlarged. Imaging can show saddle tuberculosis and Other neuroimaging findings can be identified.

5. Pituitary tumor

Often accompanied by endocrine manifestations, visual field disturbances are mostly bilateral temporal blindness. CT and MRI show sphenoid enlargement. The lesion is located in or from the saddle to the saddle, and the normal pituitary is displaced by compression.

Cavernous sinus meningiomas treatment

Follow-up observation

Suitable for small tumors, asymptomatic or mild symptoms.

2. Surgical treatment

(1) Indications: The neurological symptoms have progressed rapidly. Severe neurological dysfunction has occurred before surgery. The tumor diameter has been increased by imaging and the internal carotid artery has been significantly compressed and narrowed.

(2) The frontotemporal approach is commonly used .

(3) Common reconstruction techniques Internal carotid artery reconstruction or internal carotid artery anastomosis can be done end-to-side or end-to-end anastomosis, or saphenous artery bypass; cranial nerve reconstruction can use the gastrocnemius nerve, greater auricular nerve or supraorbital nerve; cranial Bottom reconstruction can be done with autologous fat, muscle packing and medical glue.

(4) Risk of surgery: Internal carotid artery injury causes fatal hemorrhage; cranial nerve injury.

(5) Influencing factors of the degree of surgical resection: The histological nature of the tumor; the carotid artery and its branches involvement; the extent of the cranial nerve involvement in the cavernous sinus; the origin of the tumor from the cavernous sinus.

3. Radiotherapy

(1) Residues or recurrences after the indications ; those who are difficult to tolerate surgery in the elderly or general conditions; those who are not willing to undergo surgery for small meningiomas.

(2) Methods Stereotactic radiosurgery.

(3) Complications of cerebral edema (most common in 3-9 months after irradiation); epilepsy; cranial nerve damage; carotid cavernous sinus occlusion.

Cavernous sinus meningioma prognosis

Surgical resection of cavernous sinus meningiomas has the risk of damaging the internal carotid artery and multiple cranial nerves in the cavernous sinus. Surgery indications should be strictly grasped, and follow-up observations, total surgery, partial resection + stereotactic radiosurgery, Individualized protocol for pure stereotactic radiosurgery.