Introduction: Pathologies involving the cavernous sinus (CS) are one of the most challenging lesions
to approach. The complexity of the surrounding anatomy, nerves disposition, rich venous
drainage system, and the multiplicity of tiny arteries arising are some examples of
how difficulty can be to reach these lesions.
Objective: We aim to describe the transcavernous approach, its nuances, and long-term follow-up
outcomes.
Methods: We present a single institution case series from between December 2012 and July 2021.
All 41 patients underwent an orbitozygomatic craniotomy for a transcavernous approach
(TcA). All clinical data were retrospectively reviewed. All the pre- and postoperative
CTs/MRIs were reviewed and summarized.
Results: All the patients underwent an orbitozygomatic craniotomy, an extra dural clinoidectomy,
and a middle fossa peeling. Opening the oculomotor, supratrochlear, and infratrochlear
triangles allowed us to navigate into the cavernous sinus. We identified seven meningiomas
and two hemangiomas that were intrinsically CS tumors. However, most lesions were
only invading the CS. Most of these patients were female (31 patients). The mean length
of stay was 5 days. No CSF leak or infection were reported. One craniopharyngioma
case had severe hyponatremia. A postoperative angio-CT scan was performed within 3
months in the aneurysm cases, and no residual neck were identified. Tumor cases’ follow-up
mean was 3 years with annual MRIs. Only five patients lost their follow-up within
the first year. Only Two cases of grade-II meningioma were submitted to radiotherapy.
Conclusion: The TcA provides excellent exposure to lesions located in the cavernous sinus, interpeduncular
fossa and prepontine cistern. It is a safe procedure with minimal morbidity in selected
patients.
Fig. 1
