Surgical removal of a cavernous sinus chondroma

Chondromas at the base of the skull are most commonly found in the parasellar and sellar regions, and present varying degrees of involvement of the cavernous sinus. However, those confined mainly to the cavernous sinus are rare, and only a few reports show detailed radiological and surgical findings.

This 40-year-old woman experienced sudden right orbital pain followed by right third and sixth cranial nerve palsies. Computerized tomography scan and magnetic resonance image depicted a well-circumscribed mass in the right cavernous sinus. A frontotemporal craniotomy with orbito-zygomatic osteotomy was used to approach this lesion intradurally. We drilled away the anterior clinoid process using a high-speed air drill extradurally, exposed the intrapetrous carotid artery, and dissected the right sylvian fissure from the distal, fully exposing the surface of the right cavernous sinus. The soft and grayish tumor was easily removed using sucker and tumor forceps; the venous bleeding from the sinus itself was easily controlled.

The tumor was successfully removed via a superior triangle. Intradural invasion of the tumor and heavy venous bleeding from the sinus were not observed. Histologically, the mass was diagnosed as a mature chondroma. The tumor was presumed to originate from the right posterior clinoid process. The lesion was totally removed, and postoperative right ophthalmoplegia had fully disappeared within 6 months after surgery.

Successful surgical attack of lesions in the cavernous sinus requires comprehensive and precise knowledge of the microsurgical anatomy and neuroradiology.