perineural spread of SCC

[Tim-Davis]

  My father has just undergone surgery via craniotomy for perineural spread of a SCC. via his trigeminal nerve into his cavernous sinus.  1/3 of tumour removed.  SCC from forehead totally removed 2 years ago.  Presenting symptoms were those of trigeminal neuralgia and a few weeks ago a 3rd and 6th nerve palsy developed.
  What is the prognosis and the best form of treatment?
  Is Gamma knife surgery a possibility?
  Thankyou for your assistance.
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Dear Tim,
The region of the cavernous sinus has traditionally been a pandora's box for neurosurgeons.  The reason is that the cavernous sinus and the region around it carry a number of cranial nerves (3rd, 4th, 5th and 6th) and the internal carotid artery.  Historically, surgery in this region has resulted in a relatively high incidence of injury to these nerves.  Patients can have dysfunction in eye movements and numbness in the face that can be disabling.  In spite of this, there have been many advances in cavernous sinus surgery in the past 10-20 years.
With that said, you should be sure your father is evaluated by a neurosurgeon.  In all likelihood, he will recommend radiation treatment, though much of this depends on the appearance of the tumor on the MRI.  The Gamma Knife may be an option, again depending on the MRI.
Speak to the neurosurgeon about the best option in your father's case.
Good luck.