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Segna E, Civita F, Denaro N, Beltramini GA. Cavernous sinus metastasis in head and neck cancer: Focus on oral squamous cell cancer. Oral Oncol 2024; 152:106784. [PMID: 38593719 DOI: 10.1016/j.oraloncology.2024.106784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/11/2024]
Abstract
Intracranial metastatic disease is rarely found in head and neck cancer (HNC), in particular, cavernous sinus (CS) involvement is difficult to recognize, because of its rarity, not specific symptoms associated and challenging imaging features. We report our experience in 4 cases, reviewing also the English literature. We analysed data from 21 patients showing that CS metastasis is a dramatic event, with rapid onset, usually starting with neurological manifestations (ophthalmoplegia, headache and trigeminal dysesthesia) and almost unavoidable outcome (DOD in 18/21 patients). Furthermore, we assessed that the diagnostic confirmation could be difficult to perform because of the need for multiple exams and time consuming procedures. Unfortunately, usual antineoplastic therapies seem to be not effective in prolonging survival, also because patients are already weakened by primary tumour treatments. The only option that seems useful in improving outcomes is immunotherapy.
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Affiliation(s)
- E Segna
- Maxillo-Facial Surgery and Dental Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy.
| | - F Civita
- Maxillo-Facial Surgery and Dental Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy; Università degli Studi di Milano, Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche, Italy
| | - N Denaro
- Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy
| | - G A Beltramini
- Maxillo-Facial Surgery and Dental Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy; Università degli Studi di Milano, Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche, Italy
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2
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Pesce A, Armocida D, Fiorentino F, Ciarlo S, La Pira B, Salvati M, Frati A, Pompucci A, Palmieri M. Full-Thickness Craniodural Metastasis with Leptomeningeal Infiltration of Salivary Origin: A Radiological Lesson and a Technical Remark. Tomography 2022; 8:2164-2170. [PMID: 36136877 PMCID: PMC9498924 DOI: 10.3390/tomography8050181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/21/2022] [Accepted: 08/21/2022] [Indexed: 11/16/2022] Open
Abstract
Calvarial metastases are a relatively rare entity, with an overall incidence of 3-4%. Among these cases, metastases arising from salivary gland cancers are even rarer; in fact, large studies regarding salivary gland tumors showed that brain metastases are observed in 0.8% of the cases. Generally, bone metastases have been described in proximity to primary tumors, while bloodstream-disseminated lesions are often located inside the brain parenchyma. During every surgical step, traction on lower-lying infiltrated tissues must be avoided in order to successfully remove the lesion. This case report presents the first ever case of a 67-year-old woman affected by submandibular gland undifferentiated adenocarcinoma metastasis with a full-thickness involvement of the calvarium, pachy- and leptomeninges.
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Affiliation(s)
- Alessandro Pesce
- Neurosurgery Division, Santa Maria Goretti Hospital, 04100 Latina, Italy
| | - Daniele Armocida
- Neurosurgery Division, A.O.U. “Policlinico Umberto I”, Human Neuroscience Department, “Sapienza” University, Viale del Policlinico 155, 00161 Rome, Italy
| | | | - Silvia Ciarlo
- Neurosurgery Department, A.O.U. ‘Mater Domini’, Università degli Studi ‘Magna Greacia’ di Catanzaro, 88100 Catanzaro, Italy
| | - Biagia La Pira
- Neurosurgery Department, Azienda Ospedaliera Fabrizio Spaziani, 03100 Frosinone, Italy
| | - Maurizio Salvati
- Department of Neurosurgery, Policlinico “Tor Vergata”, University of Rome ‘‘Tor Vergata”, 00133 Rome, Italy
| | - Alessandro Frati
- Neurosurgery Division, A.O.U. “Policlinico Umberto I”, Human Neuroscience Department, “Sapienza” University, Viale del Policlinico 155, 00161 Rome, Italy
- IRCCS—“Neuromed”, Via Atinense 18, 86077 Pozzilli, Italy
| | - Angelo Pompucci
- Neurosurgery Division, Santa Maria Goretti Hospital, 04100 Latina, Italy
| | - Mauro Palmieri
- Neurosurgery Division, A.O.U. “Policlinico Umberto I”, Human Neuroscience Department, “Sapienza” University, Viale del Policlinico 155, 00161 Rome, Italy
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3
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Jadhav A, Gupta A, Bhola N, Karia H. Remote Metastasis of Oral Squamous Cell Carcinoma to Cavernous Sinus: A Report of a Rare Case. Cureus 2022; 14:e27373. [PMID: 36046276 PMCID: PMC9418633 DOI: 10.7759/cureus.27373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 07/27/2022] [Indexed: 11/18/2022] Open
Abstract
The most frequently occurring malignant tumor of epithelial origin of the head and neck region is squamous cell carcinoma (SCC). It is characterized by loco regional dissemination whilst remote metastasis (RM) is rare. The lung, bone, and liver are the frequent sites for RM whilst involvement of the brain or cavernous sinus has an exceptionally rare occurrence. Owing to its rarity, lack of awareness amongst head neck surgeons, and absence of any evidence-based protocol, the optimal management strategies in this population are controversial and, hence, associated with dismal outcomes. The present case report exhibits a rare presentation of cavernous sinus metastasis in human papillomavirus (HPV)-related primary SCC arising from the lower gingivobuccal complex.
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Nagaraja CT, Ramalingaiah AH, Arimappamagan A, Mitra S, Shukla D, Srinivas D, Krishna SS, Mahadevan A. Spectrum of Surgically Resected Lesions of the Cavernous Sinus: A Neuropathologic Audit. J Neurosci Rural Pract 2022; 13:495-509. [PMID: 35946008 PMCID: PMC9357489 DOI: 10.1055/s-0042-1750707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background
The cavernous sinus is a complex space composed of extradural venous plexus within dural folds. Several important structures like the carotid artery, cranial nerves, and sympathetic nerve fibers traverse through this space. Radiological diagnosis may not be definitive and in the context of discordance between clinical and neuroimaging diagnosis, histopathological evaluation becomes essential for diagnosis and management. Literature on the pathological spectrum of lesions is scarce as, with a shift in the treatment paradigm, most small lesions of cavernous sinus are treated with radiosurgery. However, surgical management still plays a role for larger lesions and in radiologically ambiguous cases for planning the definitive management.
Materials and Methods
We retrospectively reviewed all surgically resected lesions of the cavernous sinus over the last two decades (1998–2019). The clinical presentation, neuroimaging features, and histopathological findings were reviewed. Lesions extending from sella and other adjacent areas were excluded.
Results
Thirty-eight cases of isolated cavernous sinus mass lesions were diagnosed over the last two decades (1998–2019). Cavernous hemangiomas (19 cases, 50%) constituted the most frequent pathology, followed by aspergilloma, meningioma, schwannoma, metastatic adenocarcinoma, chondrosarcoma, and chordoma. Overall, 29.4% (10/34) could not be accurately diagnosed on neuroimaging. Of these, four cases of cavernous hemangiomas were mistaken for either meningioma (three cases) or schwannoma (one case). Neither chordoma nor chondrosarcoma was suspected.
Conclusion
This is the first study in literature, enumerating the pathological and imaging spectrum of surgically resected cavernous sinus lesions. Cavernous hemangiomas, metastases and chordomas, and chondrosarcoma posed the greatest difficulty in diagnosis on neuroimaging and the reasons for the same are analyzed. In the context of clinical and neuroimaging discordance in diagnosis, pathological characterization becomes essential for appropriate and timely management.
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Affiliation(s)
| | - Arvinda H Ramalingaiah
- Departments of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Arivazhagan Arimappamagan
- Departments of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Saikat Mitra
- Departments of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru Karnataka, India
| | - Dhaval Shukla
- Departments of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Dwarakanath Srinivas
- Departments of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Shankar S Krishna
- Departments of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru Karnataka, India
| | - Anita Mahadevan
- Departments of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru Karnataka, India
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Nassrallah G, Sun V, Guiot MC, Mikhail M, Arthurs B. Cavernous sinus syndrome associated with metastatic colorectal cancer and perineural spread along the trigeminal nerve. Am J Ophthalmol Case Rep 2017; 6:67-70. [PMID: 29260062 PMCID: PMC5722136 DOI: 10.1016/j.ajoc.2016.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 11/23/2016] [Indexed: 11/30/2022] Open
Abstract
Purpose We report the case of a patient with cavernous sinus syndrome associated with biopsy-confirmed metastasis from colorectal cancer. Observations A patient known for laryngeal carcinoma and metastatic colorectal carcinoma presented with symptoms of left trigeminal neuralgia and progressive, near-complete ophthalmoplegia. Magnetic resonance imaging (MRI) revealed a mass in the left cavernous sinus, extending into Meckel's cave with perineural spread along the mandibular branch of the left trigeminal nerve. A transsphenoidal biopsy was performed and demonstrated metastatic colon adenocarcinoma. We review the existing literature on colorectal cancer associated cavernous sinus syndrome. Conclusions and importance Cavernous sinus metastasis from colorectal cancer is exceedingly rare. We report the second case of this entity with histopathologic confirmation, and the first case with concurrent perineural spread involving the trigeminal nerve. Cavernous sinus metastasis may represent a poor prognostic factor in colorectal cancer.
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Affiliation(s)
- Georges Nassrallah
- McGill University Health Centre, 1001 Boulevard Décarie, Montreal, Quebec, Canada
| | - Vincent Sun
- McGill University Health Centre, 1001 Boulevard Décarie, Montreal, Quebec, Canada
| | | | - Mikel Mikhail
- McGill University Health Centre, 1001 Boulevard Décarie, Montreal, Quebec, Canada
| | - Bryan Arthurs
- McGill University Health Centre, 1001 Boulevard Décarie, Montreal, Quebec, Canada
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6
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Raheja A, Couldwell WT. Management of Cavernous Sinus Involvement in Sinonasal and Ventral Skull Base Malignancies. Otolaryngol Clin North Am 2017; 50:365-383. [PMID: 28314403 DOI: 10.1016/j.otc.2016.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cavernous sinus (CS) involvement by sinonasal and ventral skull base malignancies is infrequently encountered in neurosurgical practice. Despite advancements in skull base microneurosurgery and endoscopic techniques, detailed knowledge and experience of the surgical management of these lesions are limited. This article elaborates on surgical strategies and approaches for CS involvement of malignant ventral skull base tumors. The article discusses the indications, techniques, nuances, advantages, limitations, and complications of minimally invasive CS biopsy, transcranial microscopic, and transfacial endoscopic approaches to the CS using illustrative diagrams and operative videos. The principles and nuances of a high-flow cerebral revascularization procedure are mentioned.
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Affiliation(s)
- Amol Raheja
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 North Medical Drive East, Salt Lake City, UT 84132, USA
| | - William T Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 North Medical Drive East, Salt Lake City, UT 84132, USA.
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Minniti G, Esposito V, Clarke E, Scaringi C, Bozzao A, Falco T, De Sanctis V, Enrici MM, Valeriani M, Osti MF, Enrici RM. Fractionated stereotactic radiosurgery for patients with skull base metastases from systemic cancer involving the anterior visual pathway. Radiat Oncol 2014; 9:110. [PMID: 24886280 PMCID: PMC4036429 DOI: 10.1186/1748-717x-9-110] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 03/16/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To analyze the tumor control, survival outcomes, and toxicity after stereotactic radiosurgery (SRS) for skull base metastases from systemic cancer involving the anterior visual pathway. PATIENTS AND METHODS We have analyzed 34 patients (23 females and 11 males, median age 59 years) who underwent multi-fraction SRS for a skull base metastasis compressing or in close proximity of optic nerves and chiasm. All metastases were treated with frameless LINAC-based multi-fraction SRS in 5 daily fractions of 5 Gy each. Local control, distant failure, and overall survival were estimated using the Kaplan-Meier method calculated from the time of SRS. Prognostic variables were assessed using log-rank and Cox regression analyses. RESULTS At a median follow-up of 13 months (range, 2-36.5 months), twenty-five patients had died and 9 were alive. The 1-year and 2-year local control rates were 89% and 72%, and respective actuarial survival rates were 63% and 30%. Four patients recurred with a median time to progression of 12 months (range, 6-27 months), and 17 patients had new brain metastases at distant brain sites. The 1-year and 2-year distant failure rates were 50% and 77%, respectively. On multivariate analysis, a Karnofsky performance status (KPS) >70 and the absence of extracranial metastases were prognostic factors associated with lower distant failure rates and longer survival. After multi-fraction SRS, 15 (51%) out of 29 patients had a clinical improvement of their preexisting cranial deficits. No patients developed radiation-induced optic neuropathy during the follow-up. CONCLUSIONS Multi-fraction SRS (5 x 5 Gy) is a safe treatment option associated with good local control and improved cranial nerve symptoms for patients with a skull base metastasis involving the anterior visual pathway.
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Affiliation(s)
- Giuseppe Minniti
- Radiation Oncology Unit, Sant' Andrea Hospital, University Sapienza, Via di Grottarossa 1035, 00189 Rome, Italy.
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8
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Rare cranial nerve extension of a parotid tumor. Am J Med Sci 2014; 347:165-6. [PMID: 24477072 DOI: 10.1097/maj.0000000000000214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Kalani MYS, Kalb S, Martirosyan NL, Lettieri SC, Spetzler RF, Porter RW, Feiz-Erfan I. Cerebral revascularization and carotid artery resection at the skull base for treatment of advanced head and neck malignancies. J Neurosurg 2013; 118:637-42. [DOI: 10.3171/2012.9.jns12332] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Resection of cancer and the involved artery in the neck has been applied with some success, but the indications for such an aggressive approach at the skull base are less well defined. The authors therefore evaluated the outcomes of advanced skull base malignancies in patients who were treated with bypass and resection of the internal carotid artery (ICA).
Methods
The authors retrospectively reviewed the charts of all patients with advanced head and neck cancers who underwent ICA sacrifice with revascularization in which an extracranial-intracranial bypass was used between 1995 and 2010 at the Barrow Neurological Institute.
Results
Eighteen patients (11 male and 7 female patients; mean age 46 years, range 7–69 years) were identified. There were 4 sarcomas and 14 carcinomas that involved the ICA at the skull base. All patients underwent ICA sacrifice with revascularization. One patient died of a stroke after revascularization. A second patient died of the effects of a fistula between the oral and cranial cavities (surgery-related mortality rate 11.1%). Eight months after the operation, 1 patient developed occlusion of the bypass and died. Complications associated with the bypass surgery included 1 case of subdural hematoma (SDH) with blindness, 1 case of status epilepticus, and 1 case of asymptomatic bypass occlusion (bypass-related morbidity 16.7%). Complications associated with tumor resection included 3 cases of CSF leakage requiring repair and shunting, 1 case of hydrocephalus requiring shunting, 1 case of SDH, and 1 case of contralateral ICA injury requiring a bypass (tumor resection morbidity rate 33.3%). In 1 patient treated with adjuvant therapy before surgery, the authors identified only a radiation effect and no tumor on resection. In a second patient the bypass was occluded, and her tumor was not resected. The other 16 patients underwent gross-total resection of their tumor. Excluding the surgery-related deaths, the mean and median lengths of survival in this series were 13.2 and 8.3 months, respectively (range 1.5–48 months). Including the surgery-related deaths, the mean and median lengths of survival were 11.8 and 8 months, respectively (range 17 days–48 months). At last follow-up all patients had died of cancer or cancer-related causes.
Conclusions
Despite maximal surgical intervention, including ICA sacrifice at the skull base with revascularization, patient survival was dismal, and the complication rate was significant. The authors no longer advocate such an aggressive approach in this patient population. On rare occasions, however, such an approach may be considered for low-grade malignancies.
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Affiliation(s)
- M. Yashar S. Kalani
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center
| | - Samuel Kalb
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center
| | - Nikolay L. Martirosyan
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center
| | - Salvatore C. Lettieri
- 2Divisions of Plastic Surgery and
- 4Division of Plastic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Robert F. Spetzler
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center
| | - Randall W. Porter
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center
| | - Iman Feiz-Erfan
- 3Neurosurgery, Maricopa Medical Center, Phoenix, Arizona; and
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10
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Sellar and parasellar metastatic tumors. Int J Surg Oncol 2011; 2012:647256. [PMID: 22312541 PMCID: PMC3263702 DOI: 10.1155/2012/647256] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 08/11/2011] [Indexed: 11/17/2022] Open
Abstract
The sellar and parasellar (SPS) region is a complex area rich in vital neurovascular structures and as such may be the location of first manifestation of a systemic malignancy. Metastases to this region are rare; breast cancer is the most common source among those that metastasize to the SPS region. Ophthalmoplegia, headache, retroorbital or facial pain, diabetes insipidus, and visual field defects are the most commonly reported symptoms. Lack of specific clinical and radiological features renders SPS metastases difficult to differentiate from the other frequently encountered lesions in this area, especially when there is no known history of a primary disease. Currently accepted management is multimodality therapy that includes biopsy and/or palliative surgical resection, radiation, and chemotherapy. Although no significant survival benefits have been shown by the surgical series, surgical resection may improve quality of life. Here we review the relevant literature and present six illustrative cases from our own institution.
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11
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Ginsberg LE, Demonte F. Palatal adenoid cystic carcinoma presenting as perineural spread to the cavernous sinus. Skull Base Surg 2011; 8:39-43. [PMID: 17171041 PMCID: PMC1656665 DOI: 10.1055/s-2008-1058589] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Adenoid cystic carcinoma of the hard or soft palate is a slow-growing, insidious disease with a tendency to spread via a perineural mechanism along the palatine branches of the maxillary division of the trigeminal nerve. Such spread may present first as a tumor in the pterygopalatine fossa or cavernous sinus. The purpose of this manuscript is to report three cases of palatal adenoid cystic carcinoma which presented as a mass in the cavernous sinus prior to discovery of the palate primary tumor. The imaging features of these cases are emphasized as is the need to search for a head and neck primary lesion when faced with a cavernous sinus mass.
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12
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The imaging of conditions affecting the cavernous sinus. Clin Radiol 2010; 65:937-45. [DOI: 10.1016/j.crad.2010.06.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2010] [Revised: 06/11/2010] [Accepted: 06/23/2010] [Indexed: 11/16/2022]
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13
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Dumitrascu OM, Costa RM, Kirsch C, Arnold AC, Gordon LK. Cavernous Sinus Syndrome Resulting from Contiguous Spread of Adenoid Cystic Carcinoma: A Systematic Analysis of Reported Cases. Neuroophthalmology 2009. [DOI: 10.3109/01658100903226208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kano H, Niranjan A, Kondziolka D, Flickinger JC, Lunsford LD. The role of palliative radiosurgery when cancer invades the cavernous sinus. Int J Radiat Oncol Biol Phys 2008; 73:709-15. [PMID: 18692328 DOI: 10.1016/j.ijrobp.2008.05.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Revised: 05/05/2008] [Accepted: 05/05/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE Involvement of the cavernous sinus by direct invasion from skull base cancer or from metastatic spread of cancers is a challenging problem. We evaluated the role of stereotactic radiosurgery (SRS) in the treatment of patients who developed cavernous sinus metastases or direct invasion. METHODS AND MATERIALS We retrospectively reviewed the data from 37 patients who had cavernous sinus metastases or had cavernous sinus invasion from adjacent skull base cancers and who underwent SRS between 1992 and 2006 at the University of Pittsburgh Medical Center. The median patient age was 57.8 years. Previous adjuvant management included fractionated radiotherapy in 8, chemotherapy in 16, and both radiotherapy and chemotherapy in 5. The primary sites of metastases or invasion were nasopharyngeal carcinoma (n = 7), parotid gland carcinoma (n = 7), and metastases from systemic cancer (n = 23). The median target volume was 6.3 cm(3) (range, 0.3-33.6), and the median margin dose was 14 Gy (range, 12-20). RESULTS At a mean of 12.9 months (range, 0.8-63.9), 32 patients had died and 5 were living. The overall survival rate after SRS was 36.6% and 19.4% at 1 and 2 years, respectively. Progression-free survival was related to a greater marginal dose. After SRS, 12 (35.3%) of 34 patients with neurologic symptoms exhibited improvement. SRS early after diagnosis was significantly associated with improvement of cranial nerve dysfunction. CONCLUSION SRS is a minimally invasive palliative option for patients whose cancer has invaded the cavernous sinus. The benefits for cranial nerve deficits are best when SRS is performed early.
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Affiliation(s)
- Hideyuki Kano
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
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15
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Abalo-Lojo JM, Gonzalez F, Pereiro-Zabala I. Metastatic B-cell lymphoma of the cecum masquerading as Tolosa-Hunt syndrome. Can J Ophthalmol 2007. [DOI: 10.3129/can.j.ophthalmol.i07-015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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16
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Davis BAH, Monheit GD, Kline L. Metastatic skin cancer presenting as ptosis and diplopia. Dermatol Surg 2006; 32:148-58. [PMID: 16393617 DOI: 10.1111/1524-4725.2006.32024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Betty A Hinderks Davis
- Dept. of Mohs Micrographic Surgery and Cosmetic Dermatology, Arizona Medical Clinic, 14420 West Meeker Boulevard, Sun City West, AZ 85374, USA.
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18
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Maeda M, Maier SE, Sakuma H, Ishida M, Takeda K. Apparent diffusion coefficient in malignant lymphoma and carcinoma involving cavernous sinus evaluated by line scan diffusion-weighted imaging. J Magn Reson Imaging 2006; 24:543-8. [PMID: 16888792 DOI: 10.1002/jmri.20680] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To evaluate the apparent diffusion coefficient (ADC) of malignant lymphomas and carcinomas involving cavernous sinus by line scan diffusion-weighted imaging (LSDWI) and to determine the usefulness of this method for differentiating between the two tumors. MATERIALS AND METHODS Four patients with malignant lymphomas and six patients with carcinomas were prospectively studied. LSDWI images were obtained with two different b values of 5 seconds/mm(2) and 1000 seconds/mm(2) in the coronal plane. The ADC values of the two types of tumors were calculated and compared. RESULTS LSDWI provided diagnostic images with minimum susceptibility artifacts and enabled measurement of the ADC. The ADC value (mean +/- SD) was 0.51 +/- 0.06 x 10(-3) mm(2)/second in malignant lymphomas and 0.99 +/- 0.08 x 10(-3) mm(2)/second in carcinomas. A significant difference in ADC values was found between the two (P < 0.01). CONCLUSION Malignant lymphomas showed significantly lower ADC value than carcinomas. ADC provides additional useful information about differentiation between these tumors.
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Affiliation(s)
- Masayuki Maeda
- Department of Radiology, Mie University School of Medicine, Tsu, Japan.
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19
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Iwai Y, Yamanaka K, Yoshimura M. Gamma knife radiosurgery for cavernous sinus metastases and invasion. ACTA ACUST UNITED AC 2005; 64:406-10; discussion 410. [PMID: 16253685 DOI: 10.1016/j.surneu.2004.12.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2004] [Accepted: 12/29/2004] [Indexed: 11/24/2022]
Abstract
BACKGROUND We evaluated the efficacy of gamma knife radiosurgery for cavernous sinus metastases and invasion. METHOD We treated and followed up 21 patients with cavernous sinus metastases and invasion using gamma knife radiosurgery. Nine of these patients had nasopharyngeal cancer, and 12 had distant metastases from other cancers. The volume of tumors ranged from 2.9 to 50.0 (median 9.9) mL. and the radiation dose to the tumor margin was 10 to 21 (median 14) Gy. RESULTS The median follow-up period was 9 months. Clinical symptoms were improved in 48% of the patients after treatment, and tumor growth control was obtained in 67% of the patients at their final follow-up. The actual 1- and 2-year tumor growth control rates were 68% and 43%, respectively. The mean survival time was 13 months. No patient had radiation injury. CONCLUSION Gamma knife radiosurgery is a very useful therapeutic option for the treatment of cavernous sinus metastases and invasion, either as initial treatment or as an adjunct treatment for recurrences even in preirradiated patients.
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Affiliation(s)
- Yoshiyasu Iwai
- Department of Neurosurgery, Osaka City General Hospital, Osaka 534-0021, Japan.
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Yildirim N, Oksüzoğlu B, Vural M, Han O, Zengin N. Case report: cavernous sinus metastasis of the parotid carcinoma: a very unusual case. J Neurooncol 2005; 73:181-3. [PMID: 15981110 DOI: 10.1007/s11060-004-4035-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cavernous sinus is an uncommon site of metastasis for the head and neck tumors, and especially for the tumors of parotid gland. The case reported here is the second reported case of parotid carcinoma metastatic to the cavernous sinus, proven by histopathology. Also it is the first reported parotid gland acinic cell carcinoma metastasis to the cavernous sinus.
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Affiliation(s)
- Nuriye Yildirim
- Department of Medical Oncology, Ankara Numune Research and Education Hospital, Ankara, Turkey
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21
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Rossmeisl JH, Higgins MA, Inzana KD, Herring IP, Grant DC. Bilateral cavernous sinus syndrome in dogs: 6 cases (1999-2004). J Am Vet Med Assoc 2005; 226:1105-11. [PMID: 15825737 DOI: 10.2460/javma.2005.226.1105] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine clinical features, diagnostic imaging abnormalities, underlying disease, disease progression, and outcome in dogs with bilateral cavernous sinus syndrome. DESIGN Retrospective study. ANIMALS 6 dogs. PROCEDURE Dogs were included if clinical signs consistent with bilateral cavernous sinus syndrome (i.e., deficits of the third, fourth, and sixth cranial nerves and at least 1 of the first 2 branches of the fifth cranial nerve) were present and a lesion of the cavernous sinus was identified by means of diagnostic imaging or postmortem examination. RESULTS 5 dogs were evaluated because of problems referable to abnormal ocular motility or pupillomotor dysfunction, and 1 dog was evaluated because of partial motor seizures involving the face and bilateral mydriasis. Four dogs had neurologic signs referable to an extrasinusoidal lesion at the time of initial examination, and the remaining 2 dogs eventually developed extrasinusoidal signs. Besides neuroanatomic location, the only consistent neuroimaging feature was variably intense, heterogeneous enhancement of cavernous sinus lesions. Neoplasia was histologically confirmed as the underlying cause in 5 of the dogs and was suspected in the remaining dog. Median survival time for the 4 dogs that were treated was 199 days (range, 16 to 392 days). CONCLUSIONS AND CLINICAL RELEVANCE Results suggest that bilateral cavernous sinus syndrome is rare in dogs but should be suspected in dogs with compatible clinical signs. Affected dogs have a poor prognosis, and dogs with clinical signs of bilateral cavernous sinus syndrome should be systematically evaluated for neoplastic disease.
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Affiliation(s)
- John H Rossmeisl
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA
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Feiz-Erfan I, Han PP, Spetzler RF, Lanzino G, Ferreira MAT, Gonzalez LF, Porter RW. Salvage of advanced squamous cell carcinomas of the head and neck: internal carotid artery sacrifice and extracranial–intracranial revascularization. Neurosurg Focus 2003; 14:e6. [PMID: 15709723 DOI: 10.3171/foc.2003.14.3.7] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Squamous cell carcinoma (SCC) of the head and neck may involve the carotid artery (CA) in the neck or skull base. Whether tumor resection should be associated with sacrifice of the CA is debatable.
Methods
Records obtained in five consecutive patients (three men, and two women; mean age 58 years, range 47–69 years) treated for recurrent or progressive SCC involving the internal carotid artery (ICA) at the skull base were reviewed retrospectively. The ICA was sacrificed, an extracranial–intracranial (EC–IC) bypass was performed using a saphenous vein graft, and the tumor and involved ICA segment were resected.
Gross-total resection of the SCC was achieved in four cases. One patient died of an acute postoperative stroke due to bypass occlusion and did not undergo tumor resection. No other permanent ischemic or neurological deficits were noted. The other four patients died of tumor progression (survival range 2–40 months, mean 14 months). One patient survived for more than 2 years (2-year overall survival rate 20%). Histological tumor invasion of the CA wall was verified in one of the three evaluated specimens.
Conclusions
A high rate of morbidity and mortality is associated with cases in which skull base CA sacrifice and an EC–IC bypass are performed. Not all resected arteries are shown to have malignant infiltration on histological examination. Better preoperative imaging criteria are needed to define malignant infiltration of the ICA at the skull base. Chemotherapy and radiotherapy without aggressive tumor resection may be an option for these patients.
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Affiliation(s)
- Iman Feiz-Erfan
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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23
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Ampil FL, Borski TG, Nathan CAO, Mulcahy G, Walker M, Chin HW, Stucker FJ. Cavernous sinus involvement by extramedullary plasmacytoma of the sphenoid sinus. An argument for the use of adjuvant chemotherapy. Leuk Lymphoma 2002; 43:2037-40. [PMID: 12481905 DOI: 10.1080/1042819021000015998] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A 63-year-old man with cavernous sinus involvement from extramedullary plasmacytoma (EMP) of the sphenoid sinus is described. Transient resolution of retro-orbital headache and continued progression of the locally extensive tumor were noted after chemotherapy was given following a poor response to 5400 cGy of local irradiation. To determine whether adjunctive chemotherapy will improve the outcome of these particular patients, we propose that a randomized trial comparing radiotherapy to chemoradiation be conducted.
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Affiliation(s)
- Federico L Ampil
- Division of Radiation Oncology, Department of Radiology, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA 71130, USA
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Djalilian HR, Tekin M, Hall WA, Adams GL. Metastatic head and neck squamous cell carcinoma to the brain. Auris Nasus Larynx 2002; 29:47-54. [PMID: 11772490 DOI: 10.1016/s0385-8146(01)00113-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND To evaluate the natural history of patients with metastatic squamous cell carcinoma (SCCA) of the head and neck to the brain. METHODS A retrospective review of patients with brain metastases treated over a 20-year period identified five that had a head and neck SCCA primary. RESULTS Five cases of patients with SCCA of the head and neck that developed brain metastases are presented in detail. CONCLUSION In patients with aggressive disease, large infiltrative lesions, and in late survivors with initially advanced disease, metastasis to the brain should be considered. Perineural metastasis appears to be the most common mode of spread of head and neck SCCA to the brain. Pain, paresis, or paresthesias in the distribution of cranial nerves or other neurological symptoms should alert the otolaryngologist to neural or central nervous system involvement in patients with SCCA of the head and neck. Surgery with or without post-operative whole brain radiation therapy is the mainstay of treatment in most patients. Stereotactic radiosurgery may play a major role in treating brain metastases from head and neck primary tumors.
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Affiliation(s)
- Hamid R Djalilian
- Department of Otolaryngology, University of Minnesota Hospital and Clinics, Minneapolis, MN, USA
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Osguthorpe JD, Patel S. Craniofacial approaches to tumors of the anterior skull base. Otolaryngol Clin North Am 2001; 34:1123-42, ix. [PMID: 11728937 DOI: 10.1016/s0030-6665(05)70370-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
An approach that combines extracranial and intracranial components-termed a craniofacial approach-allows en bloc extirpation of paranasal malignancies that abut or penetrate the skull base. When combined with radiotherapy, cure rates for such tumors rose from near zero in the 1950s to 39% to 86% by 2000, with the higher rates reflective of esthesioneuroblastomas, well-differentiated adenocarcinomas, vasoformative tumors, and meningiomas. Transfacial tumor access can involve a transnasal (endoscopic or with magnification loupes) exposure, a midfacial degloving, or a lateral rhinotomy, depending on tumor location and size. Adjunctive exposures for tumors penetrating the nasopharynx, pterygomaxillary fossa, or sphenoid include the lateral facial split and the mandibular swing. The standard transcranial accesses are a sub-basal variation of frontal craniotomy, which encompasses en bloc the superior orbital rims, the nasion, and the lower frontal bones; or, a frontotemporal craniotomy with mobilization of the lateral orbital rim and the zygoma.
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Affiliation(s)
- J D Osguthorpe
- Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina 29425, USA
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26
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Ampil FL, Heldmann M, Ibrahim AM, Balfour EL. Involvement of the cavernous sinus by malignant (extracranial) tumour: palliation in six cases without surgery. J Craniomaxillofac Surg 2000; 28:161-4. [PMID: 10964552 DOI: 10.1054/jcms.2000.0130] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Involvement of the cavernous sinus region due to haematogenous spread or by local extension of a malignant head and neck tumour does not occur frequently. Six patients were treated by external beam radiation with (n=3) or without neoadjuvant chemotherapy between December 1989 and February 1996. Manifestations of the condition mainly consisted of fifth and sixth cranial nerve deficits (n=4). Complete resolution of cranial nerve deficits after therapy occurred in two of the four patients with only three individuals having been evaluable. Three of the six patients survived for more than 3 years. Thus, palliation can be achieved by chemoradiation or radiotherapy alone, and long term survival is not precluded.
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Affiliation(s)
- F L Ampil
- Department of Radiology, Louisiana State University, Health Sciences Center Shreveport, 71130, USA
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Saito K, Fukuta K, Takahashi M, Tachibana E, Yoshida J. Management of the cavernous sinus in en bloc resections of malignant skull base tumors. Head Neck 1999. [DOI: 10.1002/(sici)1097-0347(199912)21:8<734::aid-hed9>3.0.co;2-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Williams Z, Norbash A, Goode RL. Cavernous sinus syndrome caused by a primary paranasal sinus non-Hodgkin's lymphoma. J Laryngol Otol 1998; 112:777-8. [PMID: 9850323 DOI: 10.1017/s0022215100141660] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Although uncommon, non-Hodgkin's lymphomas occasionally arise from the nose and paranasal sinuses. Rarely, they may invade into the cavernous sinus and produce signs and symptoms that characteristically include unilateral ophthalmoplegia, sensation loss in the distribution of the ophthalmic and other divisions of the trigeminal nerve, sympathetic nerve paralysis and proptosis. In this report, we present a case of cavernous sinus syndrome (CSS) caused by infiltration of non-Hodgkin's lymphoma from the adjacent paranasal sinuses and address issues regarding its diagnosis and treatment.
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Affiliation(s)
- Z Williams
- Stanford Medical School, Stanford University Medical Center, California, USA
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Ryan MW, Rassekh CH, Chaljub G. Metastatic breast carcinoma presenting as cavernous sinus syndrome. Ann Otol Rhinol Laryngol 1996; 105:666-8. [PMID: 8712640 DOI: 10.1177/000348949610500815] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
From the Departments of Otolaiyngology-Head and Neck Surgery (Ryan, Rassekh) and Radiology (Chaljub), The University of Texas Medical Branch, Galveston, Texas.
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Affiliation(s)
- M W Ryan
- Department of Otolaryngology, Head and Neck Surgery, University of Texas Medical Branch, Galveston 77555-0521, USA
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Laccourreye O, Bély N, Halimi P, Guimaraes R, Brasnu D. Cavernous sinus involvement from recurrent adenoid cystic carcinoma. Ann Otol Rhinol Laryngol 1994; 103:822-5. [PMID: 7944176 DOI: 10.1177/000348949410301014] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- O Laccourreye
- Department of Otolaryngology-Head and Neck Surgery, Laënnec Hospital, University of Paris, France
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