Evidence-based treatment of cavernous sinus meningioma

Background: Cavernous sinus meningioma (CSM) causes gradual ophthalmoplegia and may eventually cause compression of the chiasma. The tumor is often histologically benign, slow growing, and seldom life threatening. Besides visual limitation, ophthalmoplegia causes emotional stress and disability. The tumor is commonly treated by operation, radiation, or both. While effective in varied degrees, the treatments, especially radical operation, are associated with unacceptable mortality and morbidity. The question remains as to what treatment approach is most conducive to longest survival with minimum disability. Methods: In five patients, operation, radiotherapy, or both were based on presenting symptoms or delayed based on a doctor–patient decision, seeking the most desirable and suitable option that potentially offers longer life with less disability. Results: Five patients were followed from over 2 to almost 5 decades: two patients are still alive, 25 and 28 years after craniotomy and radiation. One was treated conservatively for 15 years before requiring craniotomy and radiation. One was followed for 45 years without needing craniotomy or radiation, despite enlargement of the tumor. One was followed for 36 years after craniotomy. Patient did not have radiation. Craniotomy consisted of removing enough tumor to diminish symptoms without causing complications. There were no mortalities or complications. Conclusion: The patient number is not large enough to make a broad conclusion. However, the individualized treatments and long follow-ups, together with detailed literature review, suggest that CSM requires individualized staged treatments based on each patient’s condition. A period of “wait and see” before starting with either surgery or radiation treatment can benefit the patient. </jats:sec

Micro vascular alterations following cerebral contusion in rats

✓ Cerebral contusion was caused in 18 rats by dropping various weights on an exposed dura of one hemisphere. One or 3 hours after the injury the animals were sacrificed by perfusion with paraformaldehyde-glutaraldehyde solution. The traumatic micro vascular and neural tissue alterations were studied with light, scanning, and electron microscopic techniques. The microvascular obstructions and damage were revealed in this study as major histological alterations, causing secondary neural damage. The obstruction of the vessels appeared to have been caused 1) by extra vascular pressure from destroyed and swollen tissue, petechial hemorrhage, and dissecting extraluminal clots; and 2) by intravascular clots. Besides the tearing and shearing effects causing petechial hemorrhages, the capillary walls were often thinned and irregular.</jats:p