Surgery of tumors invading the cavernous sinus.

Potential injury to neurovascular structures within the cavernous sinus often prohibits total removal of various cranial base tumors. This report discusses the rationale of direct cavernous sinus surgery and describes a surgical technique refinement as evolved from experience in 18 histologically benign operative cases. The nature of tumor extension mandated entry to the sinus, either through the superior or lateral wall or both. The operative microscope facilitated dissecting and preserving the carotid artery and cranial nerves transversing the sinus. Venous bleeding was controlled by packing. There was one death unrelated to cavernous sinus surgery. Five patients, however, had complications related to cavernous sinus surgery, including hemiplegia in one patient and cranial nerve palsy in four.