1
|
Ahmed G, Abou-Foul M, Sage W, McConachie N. Endovascular stenting for cerebral venous sinus stenosis secondary to meningioma invasion. Neuroradiology 2024; 66:817-824. [PMID: 38429544 DOI: 10.1007/s00234-024-03321-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/20/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION Symptomatic intracranial hypertension (IH) due to venous outflow obstruction secondary to dural venous sinus (DVS) tumoral invasion affects up to 3% of intracranial meningioma patients. The literature regarding endovascular therapies of such patients is limited to a few case reports and a recent single-centre case series. PURPOSE We describe our single-centre experience of endovascular therapy in patients with clinically symptomatic IH secondary to DVS meningioma invasion. METHODS We performed a retrospective review of clinical and radiological data of all patients with refractory IH and meningiomas invading the DVS who were referred for possible DVS venoplasty and stenting. Seven endovascular procedures in six female patients were done. Presumed secondarily induced lateral transverse sinus stenosis was also stented in four patients as part of the primary intervention. RESULTS All patients experienced complete symptomatic resolution at 6-month follow-up. Five patients had no symptom recurrence over a mean follow-up period of 3.5 years. One patient with multiple meningiomas developed recurrent IH 2 years following stenting secondary to in-stent tumour re-invasion. This was re-stented with consequent 6 months post-retreatment symptomatic relief at the time of writing. No procedure-related complications occurred. CONCLUSION In the setting of DVS stenosis secondary to meningioma invasion, endovascular therapy is a safe and successful therapeutic option with promising mid-term results. The procedure should be considered in cases where complete surgical tumour resection is unlikely or carries a significant risk. If present, secondarily induced stenoses at the lateral ends of the transverse sinuses should also be considered for treatment.
Collapse
Affiliation(s)
- Gasim Ahmed
- Department of Imaging, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - Mahmoud Abou-Foul
- Department of Imaging, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - William Sage
- Department of Neurosurgery, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Norman McConachie
- Department of Imaging, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| |
Collapse
|
2
|
Jung Y, Quon JL, Drake JM. Sinus pericranii in the setting of a posterior fossa pilocytic astrocytoma: illustrative case. J Neurosurg Case Lessons 2023; 5:CASE2332. [PMID: 36941199 PMCID: PMC10550684 DOI: 10.3171/case2332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 02/06/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Sinus pericranii (SP) is a rare vascular anomaly, with an uncertain etiology. Often discovered as superficial lesions, they can be primary or secondary in nature. Herein, we report a rare case of SP in the setting of a large posterior fossa pilocytic astrocytoma associated with a significant venous network. OBSERVATIONS A 12-year-old male presented with acute clinical deterioration in extremis with a 2-month history of lethargy and headaches. Outside plain computed tomography imaging revealed a large posterior fossa cystic lesion, probably a tumor, with severe hydrocephalus. There was also a midline small skull defect at the opisthocranion, without visible vascular anomalies. An external ventricular drain was placed with rapid recovery. Contrast imaging revealed a large midline SP emanating from occipital bone with a large intraosseous, and subcutaneous venous plexus in the midline draining inferiorly into venous plexus around the craniocervical junction. A posterior fossa craniotomy without contrast imaging could have resulted in catastrophic hemorrhage. A small modified off-center craniotomy provided access to the tumor with a gross total excision. LESSONS SP is a rare but significant phenomenon. Its presence does not necessarily preclude resection of underlying tumors, provided that a careful preoperative assessment of the venous anomaly is undertaken.
Collapse
Affiliation(s)
| | - Jennifer L. Quon
- Department of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - James M. Drake
- Departments of Neurosurgery
- Surgery, University of Toronto, Toronto, Ontario, Canada; and
- Department of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| |
Collapse
|
3
|
Sumi K, Otani N, Mori F, Yamamuro S, Oshima H, Yoshino A. Venous hypertension caused by a meningioma involving the sigmoid sinus: case report. BMC Neurol 2021; 21:119. [PMID: 33731025 PMCID: PMC7968274 DOI: 10.1186/s12883-021-02144-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 03/08/2021] [Indexed: 11/21/2022] Open
Abstract
Background Intracranial venous hypertension has been associated with a few cases of meningioma secondary to compression of the venous sinus. This is the rare case of small meningioma involving the sigmoid sinus leading to intracranial venous hypertension mimicking venous thrombosis. Case presentation A 39-year-old woman suffered visual dysfunction due to bilateral papilledema. Noncontrast head computed tomography (CT) showed no intracranial space-occupying lesions or hydrocephalus. Cerebrospinal fluid examination revealed high opening pressure. Various image inspections such as three-dimensional CT angiography, magnetic resonance imaging, and cerebral angiography demonstrated a small 2.5-cm lesion causing subtotal occlusion of the dominant right sigmoid sinus. No improvement of clinical manifestations was observed after medical treatment for 6 months, so right presigmoid craniectomy was performed. Operative findings revealed that the tumor was located predominantly involving the sigmoid sinus. The pathological diagnosis was fibrous meningioma. Postoperative fundoscopic examination showed improvement of bilateral papilledema. Conclusions We treated a patient presenting with intracranial hypertension due to a small meningioma involving the sigmoid sinus. This unusual case suggests that early surgical strategies should be undertaken to relieve the sinus obstruction.
Collapse
Affiliation(s)
- Koichiro Sumi
- Division of Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Naoki Otani
- Division of Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Fumi Mori
- Division of Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Shun Yamamuro
- Division of Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Hideki Oshima
- Division of Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Atsuo Yoshino
- Division of Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan
| |
Collapse
|
4
|
Kienzler JC, Zakelis R, Marbacher S, Bäbler S, Schwyzer L, Remonda E, Fandino J. Changing the paradigm of intracranial hypertension in brain tumor patients: a study based on non-invasive ICP measurements. BMC Neurol 2020; 20:268. [PMID: 32631262 PMCID: PMC7336443 DOI: 10.1186/s12883-020-01837-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 06/22/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The ultrasound based non-invasive ICP measurement method has been recently validated. Correlation of symptoms and signs of intracranial hypertension with actual ICP measurements in patients with large intracranial tumors is controversial. The purpose of this study was to assess ICP in patients with brain tumors, presenting with neurological signs and symptoms of elevated ICP and to further evaluate the value and utility of non-invasive ICP monitoring. METHODS Twenty patients underwent non-invasive ICP measurement using a two-depth transcranial Doppler ultrasound designed to simultaneously compare pulse dynamics in the proximal (intracranial), and the distal (extracranial) intraorbital segments of the ophthalmic artery through the closed eyelid. RESULTS Forty-eight measurements were analyzed. Radiological characteristics included tumor volume (range = 5.45-220.27cm3, mean = 48.81 cm3), perilesional edema (range = 0-238.27cm3, mean = 74.40 cm3), and midline shift (mean = 3.99 mm). All ICP measurements were in the normal range of 7-16 mmHg (ICPmean: 9.19 mmHg). The correlation of demographics, clinical and radiological variables in a bivariate association, showed a statistically significant correlation with neurological deficits and ICPmax (p = 0.02) as well as ICPmean (p = 0.01). The correlation between ICP and neurological deficits, showed a negative value of the estimate. The ICP was not increased in all cases, whether ipsilateral nor contralateral to the tumor. The multivariate model analysis demonstrated that neurological deficits were associated with lower ICPmax values, whereas maximum tumor diameter was associated with larger ICPmax values. CONCLUSIONS This study demonstrated that ICP in patients with intracranial tumors and mass effect is not necessarily increased. Therefore, clinical signs of intracranial hypertension do not necessarily reflect increased ICP.
Collapse
Affiliation(s)
- Jenny C Kienzler
- Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse, CH-5001, Aarau, Switzerland.
| | - Rolandas Zakelis
- Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse, CH-5001, Aarau, Switzerland.,Kaunas University of Technology, Health Telematics Science Institute, Kaunas, Lithuania
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse, CH-5001, Aarau, Switzerland
| | - Sabrina Bäbler
- Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse, CH-5001, Aarau, Switzerland
| | - Lucia Schwyzer
- Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse, CH-5001, Aarau, Switzerland
| | - Elke Remonda
- Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse, CH-5001, Aarau, Switzerland
| | - Javier Fandino
- Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse, CH-5001, Aarau, Switzerland
| |
Collapse
|
5
|
Yin T, Lin K, Wang J, Zhang L, Wang S. Letter: Advances in the Understanding of Meningiomas Involving the Superior Sagittal Sinuses. Neurosurgery 2020; 87:E74-E76. [DOI: 10.1093/neuros/nyaa087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
6
|
Türay S, Kabakuş N, Hanci F, Tunçlar A, Hizal M. Cause or Consequence: The Relationship Between Cerebral Venous Thrombosis and Idiopathic Intracranial Hypertension. Neurologist 2019; 24:155-60. [DOI: 10.1097/nrl.0000000000000242] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
7
|
Sharma N, Hitti FL, Liu G, Grady MS. Pseudotumor cerebri comorbid with meningioma: A review and case series. Surg Neurol Int 2018; 9:130. [PMID: 30105128 PMCID: PMC6044140 DOI: 10.4103/sni.sni_484_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 05/18/2018] [Indexed: 12/16/2022] Open
Abstract
Background Pseudotumor cerebri (PTC), which has a prevalence in the general population of 1 to 2 out of 100,000, presents with raised intracranial pressure (ICP) but generally lacks a space occupying lesion. Case Description Patient 1 is a 32-year-old woman with a history of multiple meningiomas. Upon presentation to our institution, her clinical exam was notable for a right sixth nerve palsy. An integrated diagnosis of PTC was made and shunting for the cerebrospinal fluid (CSF) diversion was recommended. Approximately 6 weeks after surgery, the patient exhibited complete symptom resolution and discontinued all medications. Patient 2 is a 40-year-old woman with history of meningioma causing partial obstruction of the right transverse sigmoid sinus. She agreed to undergo surgery for the left ventriculoperitoneal (VP) shunt placement, for management of her PTC. Postoperatively, the patient reported that her vision significantly improved. Patient 3 is a 49-year-old woman with history of meningioma who presented with left visual field cut. A right frontal VP shunt was recommended for the treatment of PTC. Postoperatively, the patient reported significant symptom improvement and resolution of visual complaints. Conclusion This case series demonstrates that it is important to keep PTC in the differential diagnosis even when mass lesions such as meningiomas are discovered. Although PTC, as the name indicates, is classically diagnosed in patients without intracranial tumors, it is critical that this not be used as an absolute exclusion criterion. Finally, this case series supports the hypothesis that venous obstruction can result in PTC.
Collapse
Affiliation(s)
- Nikhil Sharma
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Frederick L Hitti
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Grant Liu
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - M Sean Grady
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, USA
| |
Collapse
|
8
|
Amuluru K, Al-Mufti F, Shah M, Prestigiacomo CJ, Liu JK, Gandhi CD. Acquired Sinus Pericranii Due To Parasagittal Meningiomatous Invasion of the Superior Sagittal Sinus and Bilateral Transverse Sinuses. World Neurosurg 2016; 98:872.e5-872.e9. [PMID: 27923751 DOI: 10.1016/j.wneu.2016.11.129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/23/2016] [Accepted: 11/24/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Sinus pericranii is a rare vascular anomaly characterized by abnormal connections between the extra- and intracranial venous systems. Although the etiology still remains unclear, sinus pericranii is usually congenital in nature, or less likely may be secondary to spontaneous or traumatic causes. CASE DESCRIPTION We present a unique case of spontaneous sinus pericranii secondary to a parasagittal meningioma invading and occluding the superior sagittal sinus, torcula herophilii, and bilateral transverse sinuses. The resultant venous outlet obstruction and venous hypertension may have been the inciting factors for the development of the collateral channel connecting the intra- and extracranial venous systems. CONCLUSIONS This case highlights the effect of the reversal of normal venous outflow secondary to meningiomatous occlusion of intracranial dural sinuses. Sinus pericranii may, on rare occasions, represent the sole means for intracranial venous drainage in cases of intracranial venous thrombosis or incomplete development of the cerebral venous system. Therefore, this case also highlights the importance of pretreatment evaluation of the venous drainage system in patients with sinus pericranii and those with meningiomas.
Collapse
Affiliation(s)
- Krishna Amuluru
- Department of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, New Jersey, USA; Department of Interventional Neuroradiology, University of Pittsburgh Medical Center - Hamot, Erie, Pennsylvania, USA.
| | - Fawaz Al-Mufti
- Department of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, New Jersey, USA
| | - Manan Shah
- Department of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, New Jersey, USA
| | - Charles J Prestigiacomo
- Department of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, New Jersey, USA; Department of Neurology, Rutgers University School of Medicine, Newark, New Jersey, USA; Department of Radiology, Rutgers University School of Medicine, Newark, New Jersey, USA
| | - James K Liu
- Department of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, New Jersey, USA
| | - Chirag D Gandhi
- Department of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, New Jersey, USA; Department of Neurology, Rutgers University School of Medicine, Newark, New Jersey, USA; Department of Radiology, Rutgers University School of Medicine, Newark, New Jersey, USA
| |
Collapse
|
9
|
Deibert CP, Kondziolka D. Stereotactic radiosurgery used to manage a meningioma filling the posterior two-thirds of the superior sagittal sinus. J Neurosurg 2013; 119:1156-8. [PMID: 23991841 DOI: 10.3171/2013.7.jns13623] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Intrinsic meningiomas of the superior sagittal sinus pose a significant technical challenge, particularly in the posterior two-thirds of the sinus. Resection is curative but frequently is not possible because of the involvement of critical vascular structures. Here, the authors present the case of a 49-year-old woman with a recurrent meningioma located exclusively in the posterior two-thirds of the sagittal sinus. The patient was treated with a margin dose of 12 Gy and a maximum dose of 24 Gy to the length of the tumor, which measured 16 cm. Five years after treatment, the tumor remains stable and the patient is symptom free. This case demonstrates the unique role that stereotactic radiosurgery can play in the management of meningiomas that are surgically unresectable and have no accepted form of treatment. To the authors' knowledge, 16 cm also represents the longest segment of tumor treated using stereotactic radiosurgery.
Collapse
Affiliation(s)
- Christopher P Deibert
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and
| | | |
Collapse
|
10
|
Blakeley JO, Evans DG, Adler J, Brackmann D, Chen R, Ferner RE, Hanemann CO, Harris G, Huson SM, Jacob A, Kalamarides M, Karajannis MA, Korf BR, Mautner VF, McClatchey AI, Miao H, Plotkin SR, Slattery W, Stemmer-Rachamimov AO, Welling DB, Wen PY, Widemann B, Hunter-Schaedle K, Giovannini M. Consensus recommendations for current treatments and accelerating clinical trials for patients with neurofibromatosis type 2. Am J Med Genet A 2011; 158A:24-41. [PMID: 22140088 DOI: 10.1002/ajmg.a.34359] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 09/23/2011] [Indexed: 12/24/2022]
Abstract
Neurofibromatosis type 2 (NF2) is a tumor suppressor syndrome characterized by bilateral vestibular schwannomas (VS) which often result in deafness despite aggressive management. Meningiomas, ependymomas, and other cranial nerve and peripheral schwannomas are also commonly found in NF2 and collectively lead to major neurologic morbidity and mortality. Traditionally, the overall survival rate in patients with NF2 is estimated to be 38% at 20 years from diagnosis. Hence, there is a desperate need for new, effective therapies. Recent progress in understanding the molecular basis of NF2 related tumors has aided in the identification of potential therapeutic targets and emerging clinical therapies. In June 2010, representatives of the international NF2 research and clinical community convened under the leadership of Drs. D. Gareth Evans (University of Manchester) and Marco Giovannini (House Research Institute) to review the state of NF2 treatment and clinical trials. This manuscript summarizes the expert opinions about current treatments for NF2 associated tumors and recommendations for advancing therapies emerging from that meeting. The development of effective therapies for NF2 associated tumors has the potential for significant clinical advancement not only for patients with NF2 but for thousands of neuro-oncology patients afflicted with these tumors.
Collapse
|
11
|
Abstract
PTC is a clinical entity of uncertain etiology characterized by intracranial hypertension. The syndrome classically manifests with headaches and visual changes in women with obesity. Traditionally, imaging ruled out secondary causes of elevated CSF pressure but now may reveal findings frequently seen in patients with PTC, including the following: flattening of the globe, an empty sella, an enlarged ONS, protrusion and enhancement of the optic nerve head, and increased tortuosity of the optic nerve. Novel imaging methods, including MR venography, have additionally identified sinovenous stenosis as a potential indicator of PTC.
Collapse
Affiliation(s)
- A J Degnan
- Department of Radiology, George Washington University Hospital, Washington, DC, USA
| | | |
Collapse
|