Cavernous Sinus Hemangioma: Surgical Aspects

Resection of lesions in the cavernous sinus remains a challenge to neurosurgeons due to its complex anatomy. This video (Video 1) presents the most relevant landmarks of the cavernous sinus region, helping to understand the surgical anatomy. A 55-year-old female presented with diplopia, partial ptosis, and facial dysesthesia in the left ophthalmic territory. Magnetic resonance imaging revealed a lesion in the left cavernous sinus. Microsurgical resection was performed through an approach that included a fronto-orbital craniotomy, an extradural clinoidectomy, and intradural resection of the lesion through the anteromedial triangle. This maneuver expands the optic-carotid and carotid-oculomotor space, therefore the operative corridor.^1,2 Both the carotid and optic nerves are untethering and can be gently and safely mobilized. The result of the histopathologic study was hemangioma. Despite the complex anatomy and surgical challenges, it is possible to treat lesions in the cavernous sinus region without causing major deficits, mainly in the nonmeningioma tumors. This is why it is important to choose a safe route to the sinus, such as the anteromedial or Parkinson triangle.³.