OUTCOME OF AGGRESSIVE REMOVAL OF CAVERNOUS SINUS MENINGIOMAS

Despite recent advances in surgery of the cavernous sinus, meningiomas in that area offer a formidable challenge. The rationale for aggressi ve surgical removal of cavernous sinus meningiomas is based on the pre sumption that the extent of removal is inversely related to the rate o f recurrence. Over the past 10 years, 41 patients with histologically benign meningiomas involving the cavernous sinus underwent aggressive surgery. Total removal, as confirmed by intraoperative inspection and postoperative radiological studies, was achieved in 31 patients (76%). Twelve patients have been followed for more than 5 years; 10 underwen t total tumor removal and only one of these experienced recurrence (5 years after surgery). The other two patients underwent subtotal remova l and had symptomatic and radiological evidence of regrowth 3 and 4 ye ars after surgery. Pre-existing cranial nerve deficits improved in onl y 14% of the patients, remained unchanged in 80%, and worsened permane ntly in 6%. Seven patients experienced a total of 10 new cranial nerve deficits, four of which involved the nerves subserving ocular motor f unction. Extraocular muscle function did not worsen in the 25 patients with a seeing eye ipsilateral to the tumor, and no instance of visual worsening occurred. Two patients died 4 months after surgery, one fro m severe delayed vasospasm and hypothalamic infarction and the other b ecause of a myocardial infarction. Another patient died from a pulmona ry embolus on the 9th postoperative day. There were three instances of cerebral ischemia; one was transient, lasting less than 24 hours, whi le two were related to injury of the middle cerebral artery and result ed in residual hemiplegia. Other complications included three cases of nonfatal pulmonary emboli, two cerebrospinal fluid leaks, and one ins tance each of exposure keratitis, acute hypothyroidism, and cerebral e dema.