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Sphenoidal and cavernous sinus resection for tumor.

P J Donald1, J Boggan

  • 1Department of Otolaryngology-Head and Neck Surgery, University of California, Davis.

The Journal of Otolaryngology
|April 1, 1990
PubMed
Summary
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Surgical advancements now allow for the resection of aggressive sphenoid sinus tumors, previously considered inoperable. This improved surgical technique offers a curative option for patients with these challenging neoplasms.

Area of Science:

  • Neurosurgery
  • Otolaryngology
  • Oncology

Background:

  • Sphenoid sinus tumors, particularly malignant and locally invasive types, were historically deemed inoperable and incurable.
  • Fear of complications near the cavernous sinus, internal carotid artery, optic chiasm, and middle fossa limited treatment options to palliative irradiation and chemotherapy.

Purpose of the Study:

  • To evaluate the efficacy and safety of advanced surgical techniques for resecting sphenoid sinus tumors previously considered unresectable.
  • To demonstrate the feasibility of combined subcranial and intracranial resection for extensive sphenoid sinus malignancies.

Main Methods:

  • Eight patients with sphenoid sinus tumors underwent extensive surgical resection.
  • Procedures included exenteration of sinus walls, partial cavernous sinus removal, internal carotid artery skeletonization, anterior and middle fossa dura resection, and occasional temporal lobe excision.

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  • Management of potential hemorrhage from the cavernous sinus and internal carotid artery control were critical components.

    • Main Results:

    • No perioperative deaths occurred in the eight patients.
    • Seven out of eight patients are alive and well with no evidence of tumor recurrence.
    • One patient experienced local recurrence due to inadequate margins but showed no recurrence within the sphenoid sinus, cavernous sinus, or middle cranial fossa.

    Conclusions:

    • Advanced surgical techniques have significantly improved the resectability and curability of malignant and locally invasive sphenoid sinus tumors.
    • These complex procedures, when managed with meticulous attention to vascular and neural structures, offer a viable alternative to palliative care for selected patients.