Cavernous sinus meningioma – upfront radiosurgery





















SKULL BASE REGION Right cavernous sinus
HISTOPATHOLOGY N/A
PRIOR SURGICAL RESECTION No
PERTINENT LABORATORY FINDINGS N/A


Case description


A 46-year-old male patient presented with V1 and V2 trigeminal neuralgia and hypesthesia as well as nonspecific headaches. Brain magnetic resonance imaging (MRI) revealed a cavernous sinus meningioma (CSM) ( Figure 5.22.1 ). Radiosurgery was recommended due to the lesion’s volume and the anatomical location in a symptomatic patient ( Figure 5.22.2 ).

















Radiosurgery Machine Gamma Knife – Perfexion
Radiosurgery Dose (Gy) 14, at the 50% isodose line
Biologically Effective Dose (Gy) 88.05 Gy
Number of Fractions 1



Figure 5.22.1.


T1-gadolinium injected MRI in axial (left) and coronal (right) planes showing a lesion compatible with a cavernous sinus meningioma (CSM) that is infiltrating the foramen ovale.



Figure 5.22.2.


From left to right: coronal T1 injected, coronal T2 TSE (green is the 8-Gy isodose line corresponding to the conservative maximal dose that should be received by the optic pathways), and axial T1-gadolinium injected MRI. The dosimetry is colored in yellow and corresponds to the 14-Gy dose prescription. The optic chiasm (in magenta) received less than 8 Gy.



















Critical Structure Dose Tolerance
Optic pathways


  • The maximal dose to the optic pathways in patients without prior radiotherapy was classically 8 Gy



  • Recently, the dose limit has been extended to 10 or even 12 Gy

Cavernous internal carotid artery (ICA)


  • New or progressive ICA stenosis/occlusion after stereotactic radiosurgery for cavernous sinus meningiomas is considered common by some authors



  • ICA encasement or constriction increases the risk of ICA stenosis/occlusion, but the risk of ischemic complications is very low

Cavernous sinus neural contents Cranial nerves within the cavernous sinus are more radioresistant compared to the optic nerve; however, they are considered more sensitive in case of prior irradiation

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Apr 6, 2024 | Posted by in GENERAL RADIOLOGY | Comments Off on Cavernous sinus meningioma – upfront radiosurgery

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