Cavernous Hemangiomas of the Cavernous Sinus: Report of Experience with 27 Cases

Abstract

Objective: The clinical, radiological, and surgical issues concerning cavernous hemangiomas located within the dural confines of the cavernous sinus were analyzed on the basis of an experience with 27 cases. Material and Methods: The clinical and surgical outcomes of one of the most benign and vascular tumors are analyzed. The feasibility of radical resection by an entirely extradural approach using a temporal surgical route to this relatively rare and formidable surgical problem was investigated. Twenty-seven patients, 9 males and 18 females, were treated from 1992 to 2011. The patients' ages ranged from 15 to 55 years. Headaches and deficits of the cranial nerves coursing through the cavernous sinus were the principal symptoms at presentation. Vision was affected in seven cases. The radiological features were similar, with a characteristic pattern of extension and encasement of internal carotid artery. The maximum size of the tumor was 21 to 73 mm (mean, 42 mm). An entirely extradural route using the basal temporal approach was used. Results: Total resection was achieved in 22 cases. Two patients died following surgery. Follow-up ranged from 9 months to 17 years. The outcome of extraocular movements was poor in our series, possibly due to the massive sizes of the tumors encountered. There was no recurrence or growth of the residual tumor, and all surviving patients are leading active lives. Conclusions: Radical surgery can be safe and effective but can be difficult and life-threatening. The extradural surgical route is the most rational option.