George Bernard, Ferrario Cristina Anastasia, Blanquet Alexandre, Kolb Frédéric
Department of Neurosurgery, Hôpital Lariboisière, Paris, France.
Neurosurgery. 2003 Apr;52(4):772-80; discussion 780-2. doi: 10.1227/01.neu.0000053364.33375.c2.
Invasive tumors involving the cavernous sinus, such as recurrent benign meningiomas or sarcomas, raise therapeutic problems that may be resolved by cavernous sinus exenteration (CSE).
Our series comprises 18 patients (9 women and 9 men ranging in age from 14 to 64 yr) who underwent CSE during the past 8 years. The tumors in these patients included 12 meningiomas, 3 chondrosarcomas, 1 rhabdomyosarcoma, 1 lipomyosarcoma, and 1 epidermoid carcinoma. Preoperative occlusion of the internal carotid artery was confirmed in 15 cases by a balloon occlusion test. Three patients had a negative balloon occlusion test, and their internal carotid arteries were preserved (n = 1) or revascularized (n = 2) through an external carotid artery-to-middle cerebral artery bypass.
CSE was performed as a primary treatment in 5 patients and after one to five recurrences in 13 patients. In all patients, CSE included the internal carotid artery and Cranial Nerves III, IV, and VI and one to three branches of Cranial Nerve V. Orbital exenteration was performed in eight patients, and partial hypophysectomy was performed in five patients. Ten patients had received radiotherapy before CSE, and five patients underwent irradiation after CSE. The operative mortality includes two patients. Cerebrospinal fluid leakage was the main complication in four patients, with three patients having meningitis. Follow-up ranged from 6 months to 5 years, with three deaths from new recurrences at 2, 3, and 4 years after CSE. As compared with their clinical courses before CSE, all patients except the two who died postoperatively benefited from CSE.
CSE has useful indications in invasive and rapidly growing tumors, including apparently benign meningiomas. A better understanding of the biological behavior of these tumors is necessary for appropriate selection of patients for CSE.
累及海绵窦的侵袭性肿瘤，如复发性良性脑膜瘤或肉瘤，会引发一些治疗难题，而海绵窦切除术（CSE）或许能解决这些问题。
我们的研究系列包括18例患者（9名女性和9名男性，年龄在14至64岁之间），他们在过去8年中接受了CSE。这些患者的肿瘤包括12例脑膜瘤、3例软骨肉瘤、1例横纹肌肉瘤、1例脂肪肉瘤和1例表皮样癌。15例患者通过球囊闭塞试验证实术前颈内动脉已被闭塞。3例患者球囊闭塞试验结果为阴性，其颈内动脉通过颈外动脉-大脑中动脉搭桥得以保留（1例）或实现血管重建（2例）。
5例患者将CSE作为初始治疗，13例患者在经历1至5次复发后接受CSE。所有患者的CSE均涉及颈内动脉以及动眼神经、滑车神经和展神经，还有三叉神经的1至3个分支。8例患者进行了眶内容摘除术，5例患者进行了部分垂体切除术。10例患者在CSE前接受了放疗，5例患者在CSE后接受了放疗。手术死亡患者有2例。脑脊液漏是4例患者的主要并发症，其中3例患者发生了脑膜炎。随访时间为6个月至5年，3例患者在CSE后2年、3年和4年因新的复发而死亡。与CSE前的临床病程相比，除2例术后死亡的患者外，所有患者均从CSE中获益。
CSE在侵袭性和快速生长的肿瘤（包括看似良性的脑膜瘤）中有实用的适应证。为CSE恰当选择患者，有必要更好地了解这些肿瘤的生物学行为。
