Pretemporal Transcavernous Approach for Resection of Non-meningeal Tumors of the Cavernous Sinus: Single Center Experience.

Meng Huang,Qing Liu,Qun Xiao,Jun Su,Wenyong Long,Qianquan Ma

doi:10.3389/fsurg.2022.810606

Abstract

ObjectivesTo study the outcomes of the pretemporal transcavernous approach in the treatment of non-meningeal tumors involving cavernous sinus and to investigate the surgical strategy for these lesions.MethodsWe conducted a retrospective study of 45 patients with non-meningeal tumors involving cavernous sinus. All 45 patients received microsurgical resection via the pretemporal transcavernous approach from April 2012 to January 2019 by the same neurosurgeon. We analyzed clinical manifestations, image data, perioperative complications, surgical outcomes, functional outcomes, and follow-up data of these patients.ResultsGross total resection was achieved in 38 cases (84.4%) of the 45 patients. Preoperatively, a total of 64 individual cranial nerves were affected. Postoperatively, 92.2% of 64 impaired cranial nerves completely or partially restored function, 7.8% had worsened function compared with their preoperative statuses, and 5 new cranial nerve deficits (CNV) were observed in five patients during the last follow-up. Seven patients presented transient new cranial nerve deficits (5 CNIII and 2 CNVI), three cases suffered transient worsen cranial nerve deficits (3 CNIII and 1 CNVII). There were no cases of intracranial hematoma, intracranial infection, cerebrospinal fluid leaks, and death. The progression of residual tumor was observed in two patients (1 chordoma and 1 pituitary adenoma).ConclusionsNon-meningeal tumors involving cavernous sinus can be safely and radically removed with less morbidity and mortality. Pretemporal transcavernous approach is an ideal approach to the cavernous sinus and can be tailored individually.

Highlights

The pathologies of the cavernous sinus (CS) tumors are various, including meningioma, pituitary adenoma, schwannoma, hemangioma, chordoma, chondroma, and so on
We describe our experience with the surgical management of non-meningeal tumors in CS via the pretemporal transcavernous approach and strategy to tailor the approach for individual neoplasm
A total of 45 patients with non-meningeal tumors of CS were enrolled in this study

Summary

Introduction

The pathologies of the cavernous sinus (CS) tumors are various, including meningioma, pituitary adenoma, schwannoma, hemangioma, chordoma, chondroma, and so on. As the most common type of tumor of CS, meningioma has attracted the most attention from neurosurgeons. Due to the low total resection rate, high rate of complications and the good response to the radiotherapy, the enthusiasm for aggressive resection for meningioma has been tempered and more attention has been switched to protect functions of the cranial nerve [1]. The studies focusing on non-meningeal tumors of the CS are relatively rare. Several studies found that the surgical outcome of non-meningeal tumors of CS is better, and cranial nerve morbidity is far less common than CS meningiomas [2, 3]. Pursuing aggressive resection and preserving cranial nerve function in non-meningeal tumors of CS is more feasible than meningioma

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