A Combined Extra and Intradural Direct Microsurgical Approach to Tumors Involving the Cavernous Sinus

ABSTRACT

A series of seven tumors involving the cavernous sinus operated on from February 1990 to March 1991 is reported. There were 3 meningiomas, 2 neurilemmomas, 1 cavernous hemangioma, and 1 pseudotumor. After a standand pterional craniotomy, bone is removed from the posterior part of the orbital roof, the optic canal, the lesser sphenoid wing, and the anterior clinoid process. Next important step of the extradural stage is unroofing petrous bone over the internal carotid artery, if the proximal control is needed, after the exposure of the foramen rotundum, ovale, and spinosum. Intradural stage is consisted of sectioning of carotid rings and identification of III, IV and V cranial nerves which is associated with removal of tumors through various triangles according to the size and location of the tumor. None of patients died or suffered permenent neurologic deficit postoperatively.