Objective: Primary cavernous sinus tumors represent a rare entity. Diagnosis and surgical management
remain challenging due to tumor location.
Methods: We retrospectively reviewed the outcome of 17 patients (76.5% female) that underwent
endoscopic endonasal surgery (EES) for primary intracavernous tumors from 2004-2011.
Results: Patients’ ages ranged from 24 to 80 years (mean, 53 years). The cohort consisted
mainly of meningiomas (47%), hemangiomas (11.8%), and V1 schwannomas (11.8%). Tumors
were located in the cavernous sinus with extension to the sella (35.3%), Meckel’s
cave (29.4%), and supraorbital fissure (11.8%). Clinical presentation was mostly a
result of intracavernous cranial nerve compression and included diplopia (64.7%),
trigeminal dysfunction (29.4%), retro-orbital pain (29.4%), and visual impairment
(17.6%). In 10 cases, the goal of surgery was biopsy and decompression. Among the
other patients, gross total resection was achieved in two, near total (>95%) in two,
and intentional subtotal (>50%) in three. Following EES, nine patients (52.9%) showed
improvement of symptoms, six (35.3%) remained unchanged, one (5.9%) showed deterioration,
and one died 3 days postoperatively because of stroke following intraoperative carotid
injury. Other complications included new cranial nerve VI palsy (n = 1) and seizures
(n = 1). No one experienced CSF leak. Based on the histological diagnosis, four patients
received adjuvant radiotherapy and one chemotherapy. During a mean follow-up of 18.6
months, no recurrences were observed.
Conclusion: Purely cavernous sinus tumors are lesions that are difficult to access by open approaches
without new neurological deficits. EES has shown acceptable results in the management
of these tumors. The risk of intracavernous carotid injury remains high.
