2025 Poster Presentations
P065: CONTEMPORARY SURGICAL MANAGEMENT OF CAVERNOUS SINUS MENINGIOMAS: SURGICAL TECHNIQUE AND CASE SERIES
Jessica Eaton, MD; Varadaraya Shenoy; Emma Celano; Andrew Montoure; Pascal Lavergne; Laligam Sekhar; University of Washington
Introduction: The cavernous sinus is an anatomically complex region of the skull base comprised of an extensive plexus of veins and sinusoids, a sinuous stretch of the ICA, and several cranial nerves. It is also bordered by the optic nerve, the temporal lobe, the pituitary, the sphenoid sinus and the pterygoid space. In more recent years, we have developed complex surgical approaches capable of accessing the cavernous sinus and dealing with potential complications.
Methods: We describe here our current patient-centered approach to tumors involving the cavernous sinus. All patients that underwent surgery with the senior author between 2005 and 2024 were retrospectively reviewed after approval by our institutional review board (IRB). Patients were included in the study if they had a lesion involving the cavernous sinus that was treated surgically. Demographic data were collected on all patients, including age, sex, and comorbidities. Diagnosis, tumor grade, and KI-67 index were all confirmed through histopathological analysis of the tumor specimen. Tumor volume, extent of resection, progression of recurrence, and various clinical outcomes were also collected. To provide a systematic way of discussing the various pathologies and localization of tumor affecting the cavernous sinus, we designed a classification system based on the tumor epicenter and extension. We defined the tumor epicenter as the main anatomic compartment that was affected by the tumor, and tumor extension as the additional anatomic compartment invaded by the tumor. We defined the epicenter and extension as either cavernous sinus, middle fossa, posterior fossa, infratemporal fossa, sella, sphenoid sinus or orbital apex/superior orbital fissure.
Results: There were 107 patients who underwent surgery for their cavernous sinus tumors, of which 51 (47.7%) were meningiomas, 17 (15.9%) were chordomas, 9 (8.4%) were chondrosarcomas, 5 (4.7%) were schwannomas, 9 (8.4%) were adenomas, 5 (4.7%) were hemangiomas, 11 (10.3%) were metastases or other tumors. In the subset of patients with meningiomas, only one was in the cavernous sinus only. The tumor epicenter was considered to be the cavernous sinus in 25 patients (49.0%), and the middle fossa dura in 26 patients (51.05%), with extension into the posterior fossa in 21 (41.2%), into the infratemporal fossa in 7 (13.7%), into the sella in 24 (47.1%), into the sphenoid sinus in 7 (13.7%) and into the orbital apex or SOF in 18 patients (35.3%). Five patients had previously undergone radiation (9.8%). Gross total resection was achieved in 9 patients (17.6%), We provide case examples and treatment strategies based on tumor epicenter and any prior radiation.
Conclusions: In our experience, cavernous sinus tumors need to be treated on an individual, patient-centered basis. Cavernous sinus meningiomas can generally be classified as arising from within the cavernous sinus, arising from outside the cavernous sinus, or as recurrent tumors, usually being operated on after prior radiation. The tumor’s epicenter, treatment history, and the patient’s goals should all be considered when choosing a treatment strategy.