Resection of Cavernous Sinus Meningioma via Lateral Orbitotomy Approach: 2-Dimensional Operative Video

Cavernous sinus meningiomas are rare benign tumors arising from the dural wall of the cavernous sinus. These complex lesions are difficult to access surgically but can lead to cranial nerve palsies if left untreated. The case described in this video involved a 14-yr-old girl who presented initially with right ocular pain at 9 yr old. Strabismus of the right eye developed when she was 10 yr old; it was treated surgically without improvement. She developed ptosis and worsening strabismus at age 13 yr, at which time magnetic resonance imaging revealed a lesion in the anterior cavernous sinus and superior orbital fissure. Given the progressively worsening oculomotor palsy and potential for future tumor growth because of her young age, the patient's family wished to pursue surgical rather than radiation treatment. The patient underwent a right lateral orbitotomy for exploration and resection of the lesion. She tolerated the procedure well. Postoperatively, she experienced improvement in her ocular pain and persistent oculomotor nerve palsy without any new neurologic deficits. Her cosmetic results from this incision were satisfactory. Postoperative computed tomography demonstrated thinning of the right lateral orbital wall and removal of the tumor. The pathological analysis of the tissue was consistent with a grade 1 meningioma. This video demonstrates the opportunity to resect a lesion from the cavernous sinus that prevents progressive cranial neuropathies. Some cavernous meningiomas are well circumscribed and can be resected totally. The patient's parents provided consent for publication.