Case Example of a Multimodality Approach to Intracranial Abnormalities

With complex neurosurgical issues, the use of several different types of treatment options are often very important. As an example, a 42-year-old male was having increasing right-sided visual difficulties. After a workup that included an MRI of the brain, he was referred to our office for definitive management and care.

His imaging demonstrated a large right-sided medial sphenoid wing meningioma, a challenging lesion to manage. The meningioma was encroaching upon the right optic nerve and causing the patient’s visual difficulties. Unfortunately, this meningioma had also invaded an important territory at the base of the skull called the cavernous sinus. As such, complete surgical cure of this was impossible from a practical standpoint. As the patient’s visual preservation was of upmost importance, we opted to proceed with a surgical debulking and resection of the tumor. We were able to safely resect the portion of the tumor causing visual difficulties and the patient went home on postoperative day three with significantly improved vision. We had, by intent, left the area that was invading the skull base and the aforementioned cavernous sinus. The cavernous sinus not only contains a number of important blood vessels, it also contains several important nerves that control eye function, among other things. When the patient had recovered from the effects of surgery, which, because of his excellent physical health, was fairly quickly, he ultimately then went on to receive stereotactic radiosurgery to the remaining meningioma that was invading within the cavernous sinus region and along the skull base. Using this multimodality approach to care, we were able to maximize the patient’s recovery, decrease potential complications, and ultimately, hopefully, give him a very good quality of life with a very low chance of a significant recurrence of the tumor. While all surgical cases are not the same, using multimodality care in the management of complex intracranial abnormalities is important.