The clinical features,intradural transcavernous surgical management and outcomes of giant cavernous sinus hemangiomas:a single-institutional experiences.

OBJECTIVE: Cavernous sinus hemangiomas (CSHs) are rare vascular tumors. Stereotactic radiosurgery (SRS) is now an effective treatment for small CSHs. The optimum treatment for giant CSHs is still controversial. This study reports the advantages of a complete intradural transcavernous approach in the total resection of CSHs.

METHODS: A total of 15 patients with giant CSH were diagnosed and treated surgically between January 2012 and January 2017. All cases were evaluated with a contrast-enhanced MRI scan and confirmed histopathologically. A complete intradural approach was used for all the patients. The clinical manifestation, radiographic characteristics, operative techniques and outcomes of these patients were analyzed.

RESULTS: Headache was the most common initial symptom, followed by decreased visual acuity and diplopia. Postoperative MRI revealed that gross total resection was achieved in 13 patients. Two patients had suffered total ipsilateral visual loss for several years before surgery, and vision improved in all left patients with preoperative visual diminution. The most common early neurological deficit was cranial nerve (CN) VI dysfunction, which was observed in 9 patients (60%, 5 new deficits). However, only 2 patients (13.3%) suffered permanent morbidity on long-term follow-up. The early postoperative morbidity rate for CN III dysfunction was 33.3% (5 patients), and only 1patient (6.7%) suffered permanent morbidity. A total of 4(26.7%) patients had slight postoperative facial numbness.

CONCLUSIONS: For giant CSHs, surgical total resection is the primary and reasonable choice. Microsurgical resection of giant CSHs through a completely intradural transcavernous approach is an alternative treatment option for giant CSHs.