Surgical Management of Tumors Arising in or Involving the Carernous Sinus.

Kim, Jung Hoon; Kim, Chang Jin; Whang, Jin

Original Article

Journal of Korean Neurosurgical Society 1996;25(3): 584-592.

Department of Neurosugery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.

ABSTRACT

The complicate neurvascular contents and anatomic location on the cavernous sinus(CS) have long been considered a true "no man's land" for direct surgical approaches. But recent work focusing on the microsurgical anatomy of the CS and its adjacent structures has made a critical contribution to our understanding and capabilities in dealing with neoplasms involving the CS, and direct surgery within the CS I s gaining wider acceptance. Fourteen patients with neoplasms arising in or involving the CS had operations between June 1989 and May 1995 in our institution. The follow-up period ranged from 2 months to 51 months. The patients age range was 28 to 61 years, with an average age of 45 years. Although many approaches to the CS have been described, we prefered the pterional approach with or without zygomatic osteotomy. Usually, we also performed orbital roof and optic canal unroofing anterior clinoid process removal, and superior orbital fissure opening. Surgical treatment consisted of total removal in two patients subtotal removal in eight, partial in three, and biopsy in one. The histologies of these patients showed eight meningiomas two neurinomas, one invasive pituitary adenoma, one chondroid chorodma, one chondrosarcoma, and one fibrosing inflammatory pseudotumor. Postoperative morbility included cerebral infarction in one patient, cerebral ischemia with inflammatory pseudotumor. Postoperative morbidity included cerebral infarction in one patient, cerebral ischemia with transient hemiparesis in three, brain swelling in two, intracerebral hemorrhage in two, and transient diabetes insipidus in one. When we compared cranial nerve function between preoperative and postoperative period, we found that most of the patients tended to remain the same with respect to their preoperative function, although some notable improvements and deteriorations occurred. No cases of CSF leakage, meninigitis and postoperative death were encountered in our series. Although the number of cases and the follow-up.

Key Words: Cavernous sinus; Neurovascular contents; Microsurgical anatomy; Direct surgical approach; Morbidity