Turkish Neurosurgery 2014 , Vol 24 , Num 5
Adenoid Cystic Carcinoma in the Cavernous Sinus Diagnosed with the Endoscopic Endonasal Approach
Yasuhiko HAYASHI1, Masayuki IWATO1, Daisuke KITA1, Katsuyoshi MIYASHITA1, Tomokazu YOSHIZAKI2, Jun-ichiro HAMADA1
1Kanazawa University, Graduate School of Medical Science, Department of Neurosurgery, Kanazawa, Ishikawa, Japan
2Kanazawa University, Graduate School of Medical Science, Department of Otolaryngology, Kanazawa, Ishikawa, Japan
DOI : 10.5137/1019-5149.JTN.9775-13.0 A 42-year-old woman presented with right oculomotor, abducens, and trigeminal palsy. Neuroimaging revealed a small lesion in the right cavernous sinus mimicking meningioma. Because the symptoms gradually worsened, the patient underwent an endoscopic endonasal transsphenoidal surgery for tumor biopsy. Histological examination of the surgical specimen revealed adenoid cystic carcinoma (ACC). Before and after the operation, no evidence of other primary lesions could be detected. The patient was treated with stereotactic radiosurgery (SRS). ACC in the cavernous sinus can be difficult to diagnosis before histological confirmation, because it is extremely rare as a primary lesion and resembles a cavernous sinus meningioma on neuroimaging studies. Two years after the first SRS, the tumor recurred along the trigeminal nerve and SRS was performed again. Our study illustrates that in case in which a lesion in the cavernous sinus progresses on neurological and neuroimaging studies, a biopsy should be taken to provide most accurate diagnosis and treatment. Keywords : Adenoid cystic carcinoma, Cavernous sinus, Endonasal approach, Endoscope, Radiosurgery
Corresponding author : Yasuhiko Hayashı, yahayashi@med.kanazawa-u.ac.jp