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Cavernous Sinus Surgery

Last Updated: March 27, 2020

Tumor Subtypes

Lesions involving the cavernous sinus have been considered a surgical challenge because of their relevant anatomic complexity, causing them to be described as “no man’s land.” Transcranial approaches have traditionally been used for treating tumors invading the cavernous sinus. This was especially the case during the late 1980s when complex skull base approaches were introduced and popularized.

However, the enthusiasm for radical skull base approaches and resections has recently dampened because of their associated high morbidity and with the development of nonsurgical therapies, such as radiosurgery.

The introduction of the endoscope to pituitary surgery revitalized interest in operating within and around the cavernous sinus, especially because of the advantages of broad peripheral and intracavitary visualization afforded via angled endoscopes and instruments. In addition, the transnasal trajectory offers unique advantages for protecting the neurovascular structures, especially for lesions that displace these structures laterally.

Lesions invading the cavernous sinus are rare entities, comprising approximately 10% to 17% of all sellar region tumors. Together, pituitary adenomas (58–78%), and chordomas/chondrosarcomas (13–17%)...