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S025: LONG-TERM CRANIAL NERVE OUTCOMES OF MICROSURGICALLY MANAGED CAVERNOUS SINUS TUMORS: A SINGLE-CENTER EXPERIENCE OF 107 PATIENTS
Varadaraya Shenoy, MD; Jessica Eaton, MD; Pascal Lavergne, MD; Laligam Sekhar, MD; University of Washington, Seattle

Background: Cavernous sinus tumors represent a significant challenge in skull base surgery due to their proximity to critical neural structures and major vessels. We sought to investigate the long-term functional and cranial nerve outcomes of microsurgery for the treatment of cavernous sinus tumors.

Methods: All tumors involving the cavernous sinus that were treated microsurgically between 2005 and 2024 were retrospectively reviewed. Tumor outcomes, cranial nerve function, and complications were assessed in the postoperative period until the last follow-up.

Results: Over the study period, 107 patients underwent microsurgical resection for cavernous sinus lesions, with 55% requiring additional treatment such as radiotherapy, chemotherapy, or repeat surgery. Mean follow-up duration was 26.3 months (range 1 week – 84 months). The frontotemporal approach was the most commonly used (65%) for tumor resection. Gross total resection was achieved in 27% (29/107) of patients. Meningioma was the most common tumor (47%), followed by chordoma (16%). Cranial nerves V (33%) and VI (28.3%) were most commonly impaired at baseline preoperative evaluation. Oculomotor nerve complete palsy decreased from 23% immediately post-op to 14% at 1-year follow-up, with some patients recovering full function. Cranial nerve VI improved postoperatively in most patients, with 80% stable or better at 1-year follow-up. Major postoperative complications (3.7%) included intracranial hematoma in 3 patients and stroke in 1 patient. Logistic regression identified tumor histology and surgical approach as predictors of GTR.

Conclusion: Our series highlights that long-term cranial nerve function preservation may be achieved by a patient-centered strategy for complex cavernous sinus tumors.

 

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