Benefits and Pitfalls of Percutaneous Biopsy for Cavernous Sinus Tumors through the Foramen Ovale: Two Case Reports

Abstract

Case 1, a 61-year-old female presented with paresthesia of her right upper lip. Computed tomography (CT) and magnetic resonance (MR) imaging with contrast material revealed an enhanced mass in the right Meckel’s cave, which included the lateral and posterior parts of the cavernous sinus and surrounded the right internal carotid artery. To establish the best surgical strategy, a percutaneous biopsy through the foramen ovale was performed, and the histological examination indicated that the tumor was a transitional meningioma. We performed combined treatment with microsurgery and radiosurgery. Case 2,a 66-year-old female presented with paresthesia of the right side of her face. MR images with gadolinium revealed an abnormal enhanced mass at the right Meckel’s cave, and a CT scan with a bone window showed a large foramen ovale in the right side. We performed a percutaneous biopsy using the same method, but this tumor was too hard to sample through the needle. Although this manipulation has the major advantage of establishing the best therapeutic strategy and avoiding unnecessary surgery, special care should be taken for hard tumors, especially for those aspirated by needle biopsy.

foramen ovale - percutaneous biopsy - cavernous sinus tumors

References

• 1 Al-Mefty O, Smith RR. Surgery of tumors invading the cavernous sinus.  Surg Neurol. 1988;  30 370-381
• 2 DeMonte F, Smith HK, al-Mefty O. Outcome of aggressive removal of cavernous sinus meningiomas.  J Neurosurg. 1994;  81 245-251
• 3 Dolenc VV. (ed) The Caverous Sinus: A Multidiscriplinary Approach to Vascular and Tumorous Lesions.. Vienna, Springer-Verlag; 1987
• 4 Hakuba A, Tanaka K, Suzuki T. et al . A combined orbitozygomatic infratemporal epidural and subdural approach for lesions involving the entire cavernous sinus.  J Neurosurg. 1989;  71 699-704
• 5 Kawasa T, Shiobara R, Toya S. Middle fossa transpetrosal approaches for petroclival meningiomas. Selective pyramid resection and radicality.  Acta Neurochir (Wein). 1994;  129 113-120
• 6 Lanzino G, Sekhar LN, Hirsch WL. et al . Chordomas and chondrosarcomas involving the cavernous sinus: review of surgical treatment and outcome in 31 patients.  Surg Neurol. 1993;  40 359-371
• 7 Perneczky A, Knosp E, Matula C. Cavernous sinus surgery: Approach through the lateral wall.  Acta Neurochir (Wien). 1988;  92 76-82
• 8 Sekhar LN, Patel S, Cusimano M. et al . Surgical treatment of meningiomas involving the cavernous sinus: evolving ideas based on a ten year experience.  Acta Neurochir Suppl. 1996;  65 58-62
• 9 Sekhar LN, Sen CN, Jho HD. et al . Surgical Treatment on intracavernous neoplasms: A four-year experience.  Neurosurgery. 1989;  24 18-30
• 10 Berk C, Honey CR. Percutaneous biopsy through the foramen ovale: a case report.  Stereotact Funct Neurosurg. 2002;  78 49-52
• 11 El-Kalliny M, Van Loveren HR, Keller JT. et al . Tumors of the lateral wall of the cavernous sinus.  J Neurosurg. 1992;  77 508-514
• 12 Sindou M, Chavez JM, Saint Pierre G. et al . Percutaneous biopsy of cavernous sinus tumors through the foramen ovale.  Neurosurgery. 1997;  40 106-111
• 13 Sindou M, Fobe JL, Berthier E. et al . Facial motor responses evoked by direct electrical stimulation of the trigeminal root. Localizing value for radiofrequency thermorhizotomy.  Acta Neurochir (Wien). 1994;  128 57-67
• 14 Sweet WH, Wepsic JG. Controlled thermocoagulation of trigeminal ganglion and rootlets for differential destruction of pain fibers: part 1 – Trigeminal neuralgia.  J Neurosurg. 1974;  39 143-156
• 15 Iwai Y, Yamanaka K, Ishiguro T. Gamma knife radiosurgery for the treatment of cavernous sinus meningiomas.  Neurosurgery. 2003;  52 517-524
• 16 Kobayashi T, Kida Y, Mori Y. Long-term results of stereotactic radiosurgery of meningiomas.  Surg Neurol. 2001;  55 325-331
• 17 Lee JY, Niranjan A, McInerney J. et al . Stereotactic radiosurgery providing long-term tumor control of cavernous sinus meningiomas.  J Neurosurg. 2002;  97 65-72
• 18 Linskey ME, Davis SA, Ratanatharathorn V. Relative roles of microsurgery and stereotactic radiosurgery for the treatment of patients with cranial meningiomas: a single-surgeon 4-year integrated experience with both modalities.  J Neurosurg. 2005;  102 59-70
• 19 Maruyama K, Shin M, Kurita H. et al . Proposed treatment strategy for cavernous sinus meningiomas: a prospective study.  Neurosurgery. 2004;  55 1068-1075
• 20 Nakaya Y, Hayashi M, Nakamura S. et al . Low-dose radiosurgery for meningiomas.  Stereotact Funct Neurosurg. 1999;  72 67-72
• 21 Rorick MB, Chandar K, Colombi BJ. Inflammatory trigeminal sensory neuropathy mimicking trigeminal neurinoma.  Neurology. 1996;  46 1455-1457
• 22 Savas A, Deda H, Erden E. et al . Differential diagnosis of idiopathic inflammatory trigeminal sensory neuropathy from neuroma with a biopsy: case report.  Neurosurgery. 1999;  45 1246-1250
• 23 Yi W, Ohman K, Brännström T. et al . Percutaneous biopsy of cavernous sinus tumour via the foramen ovale.  Acta Neurochir (Wien). 2009;  151 401-407

Correspondence