ABSTRACT
OBJECTIVE: Compared with other neural structures, optic apparatus are particularly sensitive to radiation. If tumors are adjacent to or in contact with optic apparatus, a number of limitations need to be addressed for planning radiosurgery. To avoid radiation induced optic neuropathy, we treated these lesions with fractionated stereotactic radiosurgery (FSRS). This study is undertaken to assess the efficacy of FSRS for sella and parasella tumors adjacent to or in contact with optic apparatus. METHODS: We treated 19 sellar region tumors located adjacent to or in contact with optic apparatus with fractionated stereotactic radiosurgery using the Novalis system. Seventeen patients who could be followed were included in this study. They consisted of 8 pituitary adenomas, 4 optic gliomas, 3 meningiomas, 2 craniopharyngiomas. The mean tumor volume was 16.1cc(range 1-61.1). When planning FSRS, the prescribed fractionation dose to optic apparatus below 200cGy. Follow up examinations consisted of neurological, neuroradiological, and neuroopthalmological evaluations. RESULTS: Follow-up ranged from 2 to 34 months(mean 15 months). Serial magnetic resonance imaging revealed no increase in volume of tumor in all 17 patients. No patients had radiation induced optic neuropathy. CONCLUSION: Fractionated stereotactic radiosurgery is proper innovative treatment modality for sella or parasella tumors adjacent to or in contact with optic apparatus to avoid radiation induced optic neuropathy. We need further follow-up and clinical experiences.
Subject(s)
Humans , Craniopharyngioma , Follow-Up Studies , Magnetic Resonance Imaging , Meningioma , Optic Nerve Diseases , Optic Nerve Glioma , Pituitary Neoplasms , Radiosurgery , Tumor BurdenABSTRACT
Radical removal of extensive tumors in the parasellar region, interpeduncular fossa and cavernous sinus, or the clipping of the distal posterior circulation is very difficult via conventional approach. Seven patients with tumors in the parasella, cavernous sinus and subtemporal area, and six patients with aneurysms of distal posterior circulation were treated by using cranio-orbital zygomatic approach, with good results. The advantages of this approach are minimal brain retraction, exposure of lesion in shortest distance, multidirectional viewing of the lesion and a single cranial bone flap with relative good cosmetic result. Our cases treated via this approach are yet insufficient to compare this approach with other conventional operative approach in definitive advantages but we suggest that this approach is one of the best suitable approach for deep large lesions in the anterior and middle cranial fossae.
Subject(s)
Humans , Aneurysm , Brain , Cavernous Sinus , Cranial Fossa, Middle , Skull Base , SkullABSTRACT
A rare case of chondrosarcoma of the skull in a 57 year old female is reported. The tumor was located in the right parasella region, extra-dural type. A plain skull showed amorphous calcific densities in the right parasella area. Right carotid angiogram showed a slightly opening of carotid siphon on lateral view. CT brain scan showed a irregular mottled calcific density in the right parasella area. Osteoplastic craniotomy on right frontotemporal area was performed for removal of tumor. Then, patient was improved markedly.
Subject(s)
Female , Humans , Middle Aged , Brain , Chondrosarcoma , Craniotomy , Oculomotor Nerve Diseases , SkullABSTRACT
A rare case of chondrosarcoma of the skull in a 57 year old female is reported. The tumor was located in the right parasella region, extra-dural type. A plain skull showed amorphous calcific densities in the right parasella area. Right carotid angiogram showed a slightly opening of carotid siphon on lateral view. CT brain scan showed a irregular mottled calcific density in the right parasella area. Osteoplastic craniotomy on right frontotemporal area was performed for removal of tumor. Then, patient was improved markedly.