Surgical management of large and giant cavernous sinus hemangiomas

Cavernous sinus hemangiomas (CSH) are rare vascular tumors within the cavernous sinus. Gamma Knife radiosurgery (GKS) is less effective for large and giant CSH than for smaller ones. In one of the largest single-institution series reported thus far, we present 22 patients with large (3-4 cm-diameter, six patients) and giant (>4 cm, 16 patients) CSH treated surgically between 1994 and 2011. We also review related reports published since 1999 and further compare the treatment outcomes of surgery and radiosurgery. In the present study, a modified Dolenc's epidural approach was performed in 18 patients and the intradural approach was used in four. Gross total or near-total resection was achieved in 18 patients, subtotal resection was achieved in three patients and partial resection was achieved in one patient. Postoperative ophthalmoparesis occurred in seven patients (two improved, four unchanged to preoperative, one new deficit), and decreased visual acuity occurred in one patient. The reviewed literature and our experience suggest that surgical treatment of large and giant CSH is a reasonable option. A relatively low postoperative morbidity can be achieved with minimal disturbance of cranial nerve (CN) III, particularly with early localization and preservation of CN VI. GKS could be an adjunct treatment for residual tumor.