Management of intracavernous tumours: an 11-year experience

Seventy-one patients with tumours involving the cavernous sinus (CS) were operated upon between 1979 and 1989. Fifty-four patients underwent a direct approach to the CS. The average age of these latter patients was 47 (9-69) years. The lesions included 51 benign tumours (26 meningiomas, 16 [7 invasive] pituitary adenomas, 3 trigeminal neurinomas, one chordoma, one chondroma, one craniopharyngioma, one epidermoid tumour, and one cavernous haemangioma), and 3 malignant tumours (one chondrosarcoma, one adenoid cystic carcinoma and one metastatic adenocarcinoma). Dissecting tumour away from the carotid artery was the management of choice for intracavernous tumours which involved the internal carotid artery, except when the carotid artery had already pre-operatively presented with advanced narrowing or occlusion by encasing tumour. Microsurgical technique facilitated dissection and preservation of the cranial nerves. Patients treated radically by direct CS surgery had improvement of their symptoms and signs more frequently than those patients treated by subtotal tumour removal. However, operative complications in direct CS surgery were higher than in subtotal tumour removal without CS entry.