Benign nonmeningeal tumors of the cavernous sinus

Resection of benign cavernous sinus tumors with minimum morbidity and mortality is increasingly more common. Although meningiomas have dominated most discussions, numerous nonmeningeal tumors also deserve attention because they are generally more amenable to radical surgical resection.

We reviewed the records of 40 patients (19 female and 21 male patients) who were treated surgically during a 15-year period for benign, nonmeningeal tumors of the cavernous sinus. Invasive pituitary adenomas (14 cases) and trigeminal schwannomas (13 cases) comprised the majority of tumors; the remaining tumor types were hemangioma, neurofibroma, juvenile angiofibroma, dermoid tumor, giant cell tumor, chondromyxofibroma, and chondroma. Patient age ranged from 7 to 65 years (mean, 37 yr).

All patients underwent surgery, the intent being total resection. Total resection was achieved in 33 (82.5%) of the 40 patients. Follow-up was achieved via a combination of direct patient visit or phone interview or via the referring physician. Eight patients had undergone previous surgery elsewhere, which correlated closely with complications and neurophthalmological outcomes but did not affect resectability. Postoperatively, 89.7% of the patients had either stable or improved extraocular muscle function compared with their preoperative statuses. Forty percent of the patients experienced improvement of their preoperative extraocular muscle deficits. Complications included cerebrospinal fluid leak (three cases), postoperative hemorrhage (one case), fat embolism (one case), perforator distribution infarct (one case), hydrocephalus requiring ventriculoperitoneal shunting (two cases), transient hemiparesis (one case), and diabetes insipidus (one case).

We conclude that benign nonmeningeal tumors of the cavernous sinus can be safely and radically removed and result in good long-term neuro-ophthalmological function and low morbidity and mortality. Furthermore, when compared with our previously reported results for cavernous sinus meningiomas, benign nonmeningeal tumors of the cavernous sinus carry a better chance of total removal, a lower incidence of postoperative ocular dysfunction, and a higher rate of recovery of preoperative cranial nerve deficits.