2026 Poster Presentations
P057: EXTRADURAL RESECTION OF A CAVERNOUS SINUS HEMANGIOMA VIA PARKINSON'S TRIANGLE: A CASE REPORT HIGHLIGHTING THE SURGICAL ANATOMY OF THE MIDDLE FOSSA
Eliza Maria Bertolaccini Scolin; Daniel Jaime Zeituné; José Orlando de Melo Junior; Paulo José de Melo Junior; Paulo Niemeyer Soares Filho; Instituto Estadual do Cérebro Paulo Niemeyer
Introduction: Lesions of the cavernous sinus present a challenge in neurosurgery due to the concentration of critical neurovascular structures. Cavernous sinus hemangiomas (CSHs), although rare, can cause neurological deficits by compressing adjacent cranial nerves. This report describes the surgical resection of a cavernous sinus hemangioma using an extradural approach through Parkinson’s triangle, highlighting key anatomical landmarks and technical nuances.
Objective: To provide a detailed surgical description of the resection of a cavernous sinus hemangioma via an extradural approach through Parkinson’s triangle, emphasizing the critical importance of comprehensive anatomical knowledge of the cavernous sinus and middle cranial fossa.
Methods: A 46-year-old woman presented with headache, left trigeminal paresthesia, decreased visual acuity, and diplopia. Neurological examination revealed left cranial neuropathies of nerves II, III, IV, V and VI. MRI showed a lobulated, well-defined lesion with intense and progressive contrast enhancement, centered in the left cavernous sinus and Meckel’s cave. Resection was performed through a left frontotemporal craniotomy and extradural approach. Lumbar puncture was performed to cerebral relaxation. The middle meningeal artery was coagulated and cut at the foramen spinosum. The meningo-orbital fold was incised, and the cavernous sinus and the middle fossa triangles were peeled to expose the greater superficial petrosal nerve, trigeminal branches, and trochlear nerve. Removal of the anterior clinoid process was not required. A reddish lesion was visualized within the cavernous sinus and resected en bloc through Parkinson’s triangle, preserving neurovascular structures.
Results: The patient recovered completely from symptoms, including trigeminal function, visual acuity and eye movements. Histopathological analysis confirmed the diagnosis of hemangioma, WHO grade I.
Conclusion: Hemangioma is one of the few lesions amenable to safe resection within the cavernous sinus, often with good prognosis. The extradural approach via Parkinson’s triangle is effective, and en bloc resection may be achieved. Surgical success depends on precise anatomical knowledge for safe dissection.