Infiltration of the carotid artery by cavernous sinus meningioma

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  • 1 Departments of Neurological Surgery and Pathology (Neuropathology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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✓ Intracranial meningiomas are known to infiltrate surrounding structures such as the calvaria and dural sinuses, and the brain itself. The issue of whether meningiomas invade major intracranial arteries is of clinical importance, particularly in the case of meningiomas of the cavernous sinus. If a meningioma has not invaded the carotid artery wall, complete tumor removal may be accomplished with careful dissection from the carotid artery; however, if the tumor has infiltrated the wall of the carotid artery, complete removal may require sacrifice of the artery.

To determine whether cavernous sinus meningiomas invade the carotid artery, the authors retrospectively reviewed the histopathology of 19 consecutively treated individuals whose carotid artery was sacrificed during removal of a meningioma involving the cavernous sinus. Patients were selected for carotid artery resection based on preoperative magnetic resonance imaging studies demonstrating complete encasement of the artery. Reconstruction of the carotid artery was planned depending on the results of preoperative balloon test occlusion with blood flow determinations.

None of the 19 patients had pathological evidence of malignant tumor. Eight individuals (42%) were found to have infiltration of the carotid artery by meningioma. In five cases, focal involvement of the adventitia of the carotid artery wall was noted and, in three, the vessel was infiltrated up to the tunica muscularis. In no case was the tunica muscularis invaded by tumor. Thus, meningiomas of the cavernous sinus do infiltrate the internal carotid artery and, in order to completely resect these lesions and effect a surgical cure, it may be necessary to sacrifice the carotid artery with or without reconstruction.

Contributor Notes

Address for Dr. Sekhar: Department of Neurosurgery, George Washington University Medical Center, Washington, DC.

Address reprint requests to: Mark J. Kotapka, M.D., Division of Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, Pennsylvania 19104.
  • 1.

    Al-Mefty O: Clinoidal meningiomas. J Neurosurg 73:840849, 1990 Al-Mefty O: Clinoidal meningiomas. J Neurosurg 73:840–849, 1990

  • 2.

    Cushing H, & Eisenhardt L: Meningiomas: Their Classification, Regional Behavior, Life History, and Surgical End Results. Springfield, Ill: Charles C Thomas, 1938, pp 298319 Cushing H, Eisenhardt L: Meningiomas: Their Classification, Regional Behavior, Life History, and Surgical End Results. Springfield, Ill: Charles C Thomas, 1938, pp 298–319

    • Search Google Scholar
    • Export Citation
  • 3.

    Dolenc VV, , Kregar T, & Ferluga M, et al. : Treatment of tumors invading the cavernous sinus, in Dolenc VV (ed): The Cavernous Sinus. A Multidisciplinary Approach to Vascular and Tumorous Lesions. Wien: Springer-Verlag, 1987, pp 377391 Dolenc VV, Kregar T, Ferluga M, et al: Treatment of tumors invading the cavernous sinus, in Dolenc VV (ed): The Cavernous Sinus. A Multidisciplinary Approach to Vascular and Tumorous Lesions. Wien: Springer-Verlag, 1987, pp 377–391

    • Search Google Scholar
    • Export Citation
  • 4.

    Fohanno D, & Bitar A: Sphenoidal ridge meningioma. Adv Tech Stand Neurosurg 14:137174, 1986 Fohanno D, Bitar A: Sphenoidal ridge meningioma. Adv Tech Stand Neurosurg 14:137–174, 1986

    • Search Google Scholar
    • Export Citation
  • 5.

    Linskey ME, , Sekhar LN, & Sen C: Cerebral revascularization in cranial base surgery, in Sekhar LN, & Janecka IP (eds): Surgery of Cranial Base Tumors. New York: Raven Press, 1992, pp 4568 Linskey ME, Sekhar LN, Sen C: Cerebral revascularization in cranial base surgery, in Sekhar LN, Janecka IP (eds): Surgery of Cranial Base Tumors. New York: Raven Press, 1992, pp 45–68

    • Search Google Scholar
    • Export Citation
  • 6.

    Guthrie BL, , Ebersold MJ, & Scheithauer BW: Neoplasms of the intracranial meninges, in Youmans JR (ed): Neurological Surgery. Philadelphia: WB Saunders, 1990, pp 32503315 Guthrie BL, Ebersold MJ, Scheithauer BW: Neoplasms of the intracranial meninges, in Youmans JR (ed): Neurological Surgery. Philadelphia: WB Saunders, 1990, pp 3250–3315

    • Search Google Scholar
    • Export Citation
  • 7.

    Manivel JC, & Sung JH: Pathology of meningiomas. Pathol Annu 25:159192, 1990 Manivel JC, Sung JH: Pathology of meningiomas. Pathol Annu 25:159–192, 1990

    • Search Google Scholar
    • Export Citation
  • 8.

    Rubinstein LJ: Tumors of the Central Nervous System. Atlas of Tumor Pathology, Series 2, Fascicle 6. Washington, DC: Armed Forces Institute of Pathology, 1972, pp 169204 Rubinstein LJ: Tumors of the Central Nervous System. Atlas of Tumor Pathology, Series 2, Fascicle 6. Washington, DC: Armed Forces Institute of Pathology, 1972, pp 169–204

    • Search Google Scholar
    • Export Citation
  • 9.

    Russell DS, & Rubinstein LJ: Pathology of Tumours of the Nervous System, ed 5. Baltimore: Williams & Wilkins, 1989, pp 449532 Russell DS, Rubinstein LJ: Pathology of Tumours of the Nervous System, ed 5. Baltimore: Williams & Wilkins, 1989, pp 449–532

    • Search Google Scholar
    • Export Citation
  • 10.

    Sekhar LN, , Ross DA, & Sen C: Cavernous sinus and sphenocavernous neoplasms: anatomy and surgery, in Sekhar LN, & Janecka IP (eds): Surgery of Cranial Base Tumors. New York: Raven Press, 1992, pp 521604 Sekhar LN, Ross DA, Sen C: Cavernous sinus and sphenocavernous neoplasms: anatomy and surgery, in Sekhar LN, Janecka IP (eds): Surgery of Cranial Base Tumors. New York: Raven Press, 1992, pp 521–604

    • Search Google Scholar
    • Export Citation
  • 11.

    Sekhar LN, , Sen CN, & Jho HD: Saphenous vein graft bypass of the cavernous internal carotid artery. J Neurosurg 72:3541, 1990 Sekhar LN, Sen CN, Jho HD: Saphenous vein graft bypass of the cavernous internal carotid artery. J Neurosurg 72:35–41, 1990

    • Search Google Scholar
    • Export Citation
  • 12.

    Sekhar LN, , Sen CN, & Jho HD, et al. : Surgical treatment of intracranial neoplasms: a four-year experience. Neurosurgery 24:1830, 1989 Sekhar LN, Sen CN, Jho HD, et al: Surgical treatment of intracranial neoplasms: a four-year experience. Neurosurgery 24:18–30, 1989

    • Search Google Scholar
    • Export Citation
  • 13.

    Sen C, & Sekhar LN: Direct vein graft reconstruction of the cavernous, petrous, and upper cervical internal carotid artery: lessons learned from 30 cases. Neurosurgery 30:732743, 1992 Sen C, Sekhar LN: Direct vein graft reconstruction of the cavernous, petrous, and upper cervical internal carotid artery: lessons learned from 30 cases. Neurosurgery 30:732–743, 1992

    • Search Google Scholar
    • Export Citation
  • 14.

    Sutton LN, , Gusnard D, & Bruce DA, et al. : Fusiform dilatations of the carotid artery following radical surgery of childhood craniopharyngiomas. J Neurosurg 74:695700, 1991 Sutton LN, Gusnard D, Bruce DA, et al: Fusiform dilatations of the carotid artery following radical surgery of childhood craniopharyngiomas. J Neurosurg 74:695–700, 1991

    • Search Google Scholar
    • Export Citation
  • 15.

    Yaşargil MG: Microneurosurgery. I. Microsurgical Anatomy of the Basal Cisterns and Vessels of the Brain, Diagnostic Studies, General Operative Techniques, and Pathological Considerations of the Intracranial Aneurysms. Stuttgart: Georg Thieme Verlag, 1984, Vol 1, pp 2632 Yaşargil MG: Microneurosurgery. I. Microsurgical Anatomy of the Basal Cisterns and Vessels of the Brain, Diagnostic Studies, General Operative Techniques, and Pathological Considerations of the Intracranial Aneurysms. Stuttgart: Georg Thieme Verlag, 1984, Vol 1, pp 26–32

    • Search Google Scholar
    • Export Citation

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