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Brain Tumor "Pop Up" Glossary

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Click on the BOLD (REFERENCE) to view the "Pop Up Reference" in a new, separate window (you will not leave this page).

Email Dr. Jeffery Williams. The decisions related to treatment for the skull base, cavernous sinus and clivus meningiomas depend upon the complete understanding of the competing risks vs. benefits for the different treatments. Options for skull base, olfactory groove, cavernous sinus and clivus meningioma treatments may include surgery or radiosurgery. The FSR (fractionated stereotactic radiosurgery) for skull base, cavernous sinus and clivus meningiomas is an important option for treatment. The important considerations include the size and rate of growth of the meningioma as well as the progression of any symptoms.

Click Here for Dr. Williams C.V. Curriculum Vitae: Dr. Jeffery Williams
Director, Brain Tumor Radiosurgery
The Johns Hopkins Hospital
Board Certified: Neurological Surgery
Board Certified: Radiation Oncology
Email Dr. Jeffery Williams.

Email Address: jw@jhu.edu
Phone: 410-614-2886
Fax: 410-614-2982


Meningiomas
Skull Base and
Cavernous Sinus

Meningiomas of the skull base, cavernous sinus and clivus are often successfully treated with radiosurgery.

Meningiomas of the skull base, cavernous sinus and clivus offer considerable challenges for treatment. They often encase vital structures of brain and skull including the internal carotid artery, the cranial nerves that subserve the movement of the eyes, sensation to the face, blood supply to the orbit (conical cavity holding the eyeball), the optic chiasm (crossing of the optic nerves just above the pituitary gland) and other important structures. The surgical excision is often multi-disciplinary, involving specialists from otorhinolaryngology (ENT), plastic surgery and neurosurgery. Because of the large number of different anatomic sites spanned by these tumors, total resection is often not possible.

The management of skull base meningiomas remains a challenge because of their poor surgical accessibility and proximity to important neurovascular structures. Although advances in cranial base surgical techniques have lowered surgical mortality rates dramatically, postoperative morbidity, especially in terms of new cranial neuropathies, remains significant (REFERENCE). Early postoperative functional deterioration occurred in 45 patients (60%) and ranged from mild (30 patients) to severe (three patients). Permanent functional deterioration can be associated with the following: blood supply from the basilar artery, difficulty of dissection and incomplete tumor resection.

Radiosurgery delivers high dose to the meningioma with sparing of the surrounding normal structures.

Radiosurgery allows deposition of high doses of radiation in the meningioma with sparing of the surrounding normal structures including the optic nerves and optic chiasm. Although the carotid arteries may in some cases receive radiation, the arteries have not occluded after radiosurgery. The tolerance (ability to absorb radiation and keep functioning) of the cranial nerves that subserve motion of the eye and sensation to the eye and face is very high. The tolerance of the optic nerves and chiasm is more limited. Thus, the fractionation (dividing the treatment into multiple smaller treatment) allows safe treatment. Not only is the treatment safer with fractionation, but the total dose may be escalated when compared to single fraction techniques, resulting in potentially higher rates of tumor control.

The radiosurgery can be divided into single session (one big "shot" of radiation as given via the "gamma knife") and the fractionated stereotactic radiosurgery(FSR). The gamma knife and any single session treatment may have higher risk for the cranial nerves (REFERENCE). The risk to the cranial nerves after single "shot" radiosurgery may be as high as 13% (REFERENCE).

Consult Johns Hopkins Radiosurgery for the Meningiomas of the skull base, cavernous sinus and clivus.

Johns Hopkins Radiosurgery offers considerable experience and success in the treatment of the skull base, cavernous sinus and clivus meningiomas. The results of the fractionated stereotactic radiosurgery treatments for our first patients have been published in The Journal of Radiosurgery. This manuscript may be viewed by clicking here. The results show that for meningiomas of disparate locations including the skull base, cavernous sinus and clivus and including both the benign and the atypical or malignant meningiomas, the results of treatment are very favorable. Only one patient (with atypical meningioma) required surgery for growth after radiosurgery. Importantly none of the patients sustained new neurological deficit after the radiosurgery. Radiosurgery is an important option for treatment for these meningiomas.



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