Management of the cavernous sinus in en bloc resections of malignant skullbase tumors

Background. Cavernous sinus involvement represents the most difficult probl em in en bloc resection of malignant skull base tumors. We developed three types of surgical procedures for manipulating the cavernous sinus to achiev e en bloc resection of these tumors. Methods. In a type 1 procedure, the cavemous sinus was dissected epidurally and retracted posteriorly. In a type 2 procedure, the anterolateral portio n of the cavernous sinus was excised and the carotid artery preserved. In a type 3 procedure, the entire cavernous sinus including the carotid artery was resected. Results. Of 25 malignant skull base tumors, type 1 procedures were used in 7, type 2 in 5, and type 3 in 3. For these 15 patients, 7 are in good condi tion without evidence of tumor recurrence, 2 are alive with tumor, 4 died o f tumor recurrence, and 2 died of complications. Two-year survival rates we re 54% for patients with a type 1 procedure, 100% for type 2, and 33% for t ype 3. Conclusions. Using our techniques, we could totally excise tumors impinging on the cavernous sinus. However, the advanced tumors requiring resection o f the entire cavernous sinus with the carotid artery are associated with ma jor morbidity and mortality. (C) 1999 John Wiley & Sons, Inc. Head Neck 21: 734-742, 1999.