Endonasal endoscopic approach for a giant cavernous sinus meningioma that extended to the middle cranial fossa with preoperative embolization

Ryota Tamura, Masahiro Toda, Maya Kohno, Hiroyuki Ozawa, Toshiki Tomita, Takenori Akiyama, Kaoru Ogawa, Kazunari Yoshida

Research output: Contribution to journalArticle


Background Transcranial surgery is considered more appropriate than an endonasal endoscopic approach (EEA) for a large cavernous sinus meningioma with lateral extension. Case presentation A 6-cm-diameter hypervascular meningioma around cavernous sinus invaded the orbital apex and infratemporal fossa. 80% of the tumor was removed without too much blood loss via endoscopic endonasal transpterygoidal-infratemporal approach. Preoperative embolization from some feeding arteries was done, and 80% of the tumor staining disappeared. Discussion Tumor removal rates for giant meningioma are worse with EEA than with the transcranial approach because of various anatomical limitations and blood control. Recently, EEA has become more widely used with approaches such as the transpterygoidal approach. The operation can be done safely with preoperative embolization because the operative view is clear without bleeding. Conclusion Preoperative embolization for a large hypervascular tumor makes EEA more effective. A giant meningioma can be removed by EEA if the anatomical limitations can be identified and approached safely and effectively.

Original languageEnglish
Pages (from-to)20-22
Number of pages3
JournalInterdisciplinary Neurosurgery: Advanced Techniques and Case Management
Publication statusPublished - 2016 Dec 1



  • Cavernous sinus meningioma
  • Endonasal endoscopic approach
  • Middle cranial fossa
  • Preoperative embolization

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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