Meningioma of Cavernous Sinus

Contributor:

Dr. Chris Ekong

Consultants:

Dr. Michael Schwartz
Dr. Fred Gentili
Dr. May Tsao

Case 5

Age: 34

Sex: Male

History: Diplopia since 1995.

Examination:

1999 Normal except right 6th cranial nerve palsy. 2001 right 6th cranial nerve palsy.

Treatment:

November 1999 - observation.

Progress note:

May 2001: diplopia worsens; repeat MRI done

Treatment: 2001

- ?Observation

· ?Stereotaxic Radiation #3?? surgery

- ?Surgery

To Dr. F. Gentili, Dr. M. Schwartz and Dr. M. Tsao

Dear Fred, Mike and May:

Fred, you saw this 36-year-old man with a cavernous sinus meningioma during your visit to Regina. We have been following the meningioma for the last three years or so. The most recent MRI scan seems to show about a 20% increase in size of the tumour. I think we have reached a point where we should consider a more aggressive approach. I have indicated to him that the options include stereotaxic radiation and surgery. The 1999 and the

current MRI films are posted at: http://www.medi-fax.com/atlas/braintumours/meningiomas/case5.html .

Your opinions would be greatly appreciated and if the patient concurs, I would be happy to send the patient to Toronto for further care.

Thank you.

Yours sincerely,

Chris

Dr. Fred Gentili, Neurosurgeon, Toronto

Dear Chris:

Thank you very much for your e-mail. As always you send very challenging cases. The management options for this cavernous sinus meningioma which has shown documented growth as you note includes, 1) continued conservative

approach, 2) surgery, 3) stereotactic radiation, 4) surgery + stereotactic

radiation, 5) hydroxyurea therapy. In view of the documented growth I think that treatment is indicated. Of the various options I think that surgery plus radiation or radiation alone are the most feasable options. The aim of surgery would be to remove the extra-cavernous component, obtain a definitive tissue diagnosis and in reducing tumour bulk and decompressing

neural structures such as the optic apparatus possibly make radiation less risky and more effective ( it should be noted that there is no definitive

proof for this).

Some radiotherapist still prefer to have a definitive diagnosis. Nevertheless if the patient is resistent to surgery then radiation up front is an acceptable option.

Best regards,

Fred

Dr. Mike Schwartz and Dr. May Tsao

Dear Chris,

May and I have just been going over the images on this patient.

For this case, we would prefer to see the actual images. The ones on

the web were somewhat small and the dural tail was hard to see. He is a

candidate for fractionated IMRT (intensity-modulated radiation therapy)

at Sunnybrook which offers excellent conformation to the target and

allows treatment of larger volumes than conventional radiosurgery.

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