Dumbbell-shaped middle cranial fossa meningioma with interdural cavernous sinus extension: report of two cases with complete removal.
BACKGROUND
Surgery for meningiomas involving the cavernous sinus remains controversial. Interdural cavernous sinus is called the lateral dural wall in the cavernous sinus, which is composed of two layers, the outer dural layer and the inner membranous layer. We encountered two cases of dumbbell-shaped middle cranial fossa meningioma with interdural cavernous sinus extension, which were successfully removed by surgical means.


METHODS
A 57-year-old woman presented with headache and decreased visual acuity. Neurological assessment was normal. Computed tomography and magnetic resonance imaging showed the presence of a dumbbell-shaped, smooth-contoured, well-enhanced mass in the right mesial temporal area. The lateral wall of the cavernous sinus was exposed via frontotemporal craniotomy and the tumor originating in the lateral wall was totally removed. A 41-year-old man presented with seizure attacks and drowsy mental status. Magnetic resonance imaging showed the presence of a multilobulated, well-enhanced mass in the left parasellar area. The tumor was totally resected via a transsylvian temporopolar approach. The mass originated from tentorial edge and extended into the cavernous sinus by dural penetration.


CONCLUSIONS
Middle cranial fossa meningioma with interdural cavernous sinus extension can be removed more easily than other tumors with intracavernous sinus extension and, consequently, can be safely resected without any resulting cranial nerve deficit.
Jung
Tae-Young
TY
Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital and Medical School, Gwangju 519-809, Republic of Korea.
Jung
Shin
S
Jin
Shu-Guang
SG
Jin
Yong-Hao
YH
Kim
In-Young
IY
Kang
Sam-Suk
SS
Kim
Soo-Han
SH
D000328:Adult; D002426:Cavernous Sinus / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D020226:Cavernous Sinus Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D035301:Cranial Fossa, Middle / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D018450:Disease Progression; D004388:Dura Mater / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008579:Meningioma / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology / Q000503:physiopathology; D019635:Neurosurgical Procedures / Q000379:methods; D019292:Skull Base Neoplasms / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013702:Temporal Lobe / Q000000981:diagnostic imaging / Q000293:injuries / Q000473:pathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome