Recurrent Sphenocavernous Meningioma

Mizuho Inoue; Mohamed Labib; Alexander Yang; A Samy Youssef

doi:10.1055/s-0041-1725941

Recurrent Sphenocavernous Meningioma

J Neurol Surg B Skull Base. 2021 Jun 8;83(Suppl 3):e610. doi: 10.1055/s-0041-1725941. eCollection 2022 Aug.

Authors

Mizuho Inoue¹, Mohamed Labib², Alexander Yang¹, A Samy Youssef³

Affiliations

¹ Department of Neurosurgery, University of Colorado, Aurora, Colorado, United States.
² Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States.
³ Departments of Neurosurgery and Otolaryngology, University of Colorado, Aurora, Colorado, United States.

Abstract

A case of a recurrent sphenocavernous meningioma is presented. The patient is a 42-year-old male who presented with an episode of transient right-sided numbness. A magnetic resonance imaging (MRI) revealed a large left sphenocavernous meningioma. The patient underwent a frontotemporal craniotomy for tumor resection. Near total resection was achieved with minimal residual in the left cavernous sinus (CS) and orbital apex. The pathology was consistent with meningioma, World Health Organization (WHO) grade I. A follow-up MRI was done 9 months after surgery and showed a growth of the residual tumor, which was treated with intensity modulated radiotherapy. Tumor growth was detected on serial imaging over a 4-year period. Surgical resection was offered. A left frontotemporal craniotomy with pretemporal transcavernous approach was performed. The bone flap was reopened and the dura was opened in a Y-shaped fashion. The roof of the optic canal was drilled off, and the falciform ligament was opened to decompress the optic nerve. The tumor was disconnected from the anterior clinoid region (the anterior clinoid process was eroded by the tumor) and reflected off the wall of the lateral CS. Tumor was adherent to the V2 fascicles (the lateral CS wall was resected in the first surgery) and was sharply dissected off. Gross total resection was achieved. The pathology was consistent with meningioma, WHO grade I. The patient had an unremarkable postoperative course without any new neurological deficits. The link to the video can be found at: https://youtu.be/KVBVw_86JqM .

Keywords: cavernous sinus; meningioma; recurrent; sphenocavernous.

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