Tumors of the lateral wall of the cavernous sinus

The lateral dural wall of the cavernous sinus is composed of two layers, the outer dural layer (dura propria) and the inner membranous layer. Tumors arising from the contents of the lateral dural wall are located between these two layers and are classified as interdural. They are in essence extradural/extracavernous. The inner membranous layer separates these tumors from the venous channels of the cavernous sinus. Preoperative recognition of tumors in this location is critical for selecting an appropriate microsurgical approach. Characteristics displayed by magnetic resonance imaging show an oval-shaped, smooth-bordered mass with medial displacement but not encasement of the cavernous internal carotid artery. Tumors in this location can be resected safely without entering the cavernous sinus proper by using techniques that permit reflection of the dura propria of the lateral wall (methods of Hakuba or Dolenc). During the last 5 years, the authors have identified and treated five patients with interdural cavernous sinus tumors, which included two trigeminal neurinomas arising from the first division of the fifth cranial nerve, two epidermoid tumors, and one malignant melanoma presumed to be primary. The pathoanatomical features that make this group of tumors unique are discussed, as well as the clinical and radiological findings, and selection of the microsurgical approach. A more favorable prognosis for tumor resection and cranial nerve preservation is predicted for interdural tumors when compared with other cavernous sinus tumors.