Treatment Strategies of Large and Giant Cavernous Sinus Hemangiomas: Surgery or Radiosurgery?

Background: Cavernous sinus hemangiomas (CSHs) are rare vascular tumors within the cavernous sinus. Radiosurgery is less effective for large and giant CSH than for smaller ones. Objective: To present our surgically treated 26 cases of large and giant CSHs, the largest single-institution series reported thus far, and further conduct a systematic review and meta-analysis of the treatment of CSHs including surgery and radiosurgery. Methods: A modified Dolenc epidural approach was performed in 22 patients and the intradural approach was used in 4. The tumor dissection was performed at the cranial nerve IV to V1 interval and V1 to V2 interval. Results: Gross-total/near-total resection was attained in 20 cases, subtotal resection in 5, and partial resection in 1. The mean follow-up period was 50 months (range, 6-200). Among the 23 patients with symptoms before surgery, complete remission was achieved in 14, improvement in 4, no change in 4, and deterioration in 1. The reviewed literatures shown there were no statistical differences of the improvement rate of ocular motility disorders between the surgery and radiosurgery. Conclusions: The reviewed literature and our experience suggest that surgical treatment of large and giant CSHs is a reasonable option. A relatively low postoperative morbidity can be achieved with minimal disturbance of cranial nerve III and early localization and preservation of VI. Radiosurgery could be an adjunct treatment for residual tumor.