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Extradural transcavernous approach to cavernous sinus hemangiomas.

Ashish Suri¹, Faiz U Ahmad, Ashok K Mahapatra

¹Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India. surineuro@hotmail.com

|March 1, 2007

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Cavernous sinus hemangiomas (CSHs) are rare tumors. A purely extradural transcavernous approach enables complete surgical excision with minimal complications, offering a viable treatment option.

Area of Science:

Neurosurgery
Cranial Base Surgery
Vascular Neuro-oncology

Background:

Cavernous sinus hemangiomas (CSHs) are rare parasellar tumors, accounting for <1% of masses in this region.
Their surgical excision is challenging due to location and proximity to critical neurovascular structures, often leading to significant intraoperative bleeding.

Observation:

Seven cases of CSHs were treated using a purely extradural transcavernous approach.
Common symptoms included headache, visual impairment, facial numbness, and diplopia.
Imaging revealed characteristic lesion appearances on CT and MRI, with marked enhancement post-contrast.

Findings:

The extradural transcavernous approach involved specific steps like sphenoid ridge reduction and anterior clinoid drilling.
Tumor removal was achieved through decompression and coagulation of feeding vessels.

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Complete excision was successful in six of seven patients, with transient ophthalmoparesis as the main complication.

Implications:

The purely extradural transcavernous approach is an effective technique for complete CSH resection.
This method offers a low morbidity and mortality rate for managing these complex cranial base lesions.