THE RESULTS OF SURGERY FOR BENIGN-TUMORS OF THE CAVERNOUS SINUS

CAVERNOUS SINUS SURGERY has been performed increasingly in the last 2 decades because of new knowledge and technologies. With increasing int ernational expertise in cavernous sinus surgery, the results must be a nalyzed critically to search for accurate prognosticators of outcome. We performed a retrospective review of 124 patients (40 male, 84 femal e; mean age, 45 years) who underwent cavernous sinus surgery for benig n tumors from 1983 to 1992. Sixty-five percent had tumors encasing the internal carotid artery. Mean follow-up was 29 months (median, 26 mo) . Gross total or near-total resection was possible in 80%. Patients wi th neurilemomas, angiofibromas, epidermoids, chondroblastomas, and hem angiomas were more likely to have total or near-total resection (100% versus 75%, P <0.025). Disabling complications (five cerebral infarcti ons, two meningitis, and one hydrocephalus with chiasmal prolapse) occ urred only in patients with meningiomas or pituitary adenomas. On foll ow-up, excellent/good binocular vision was achieved in 53% of patients entering surgery with excellent/good function versus 25% who entered surgery with fair/poor binocular vision (P <0.025). Ninety-three perce nt of patients had a Karnofsky score greater than or equal to 70 on fo llow-up. There were a total of 12 recurrences (10%), 6 in patients wit h meningiomas, 2 in patients with angiofibromas, 2 in patients with cr aniopharyngiomas, 1 in a patient with a pituitary adenoma, and 1 in a patient with an osteoblastoma. Patients with tumor growth or neurologi cal symptoms indicative of progressive cavernous sinus involvement sho uld undergo cavernous sinus exploration. This surgery has acceptable m orbidity and mortality and, if the tumor can be removed easily, the su rgeon should try to perform radical tumor resection. To avoid major co mplications, the surgeon must exercise utmost care to preserve the neu rovascular structures of the cavernous sinus, with special attention t o tumors that extend into the petroclival region. Better results from surgery can be expected in those patients with neurilemomas, hemangiom as, or epidermoids than in patients with meningiomas, craniopharyngiom as, or pituitary adenomas. Good functional outcome can be expected, pa rticularly if the patient's preoperative clinical status is good. Part icular attention must be paid to the reconstruction of anatomic barrie rs in order to prevent cerebrospinal fluid leakage and subsequent meni ngitis.