Management of the cavernous sinus in en bloc resections of malignant skull base tumors

BACKGROUND: Cavernous sinus involvement represents the most difficult problem in en bloc resection of malignant skull base tumors. We developed three types of surgical procedures for manipulating the cavernous sinus to achieve en bloc resection of these tumors. METHODS: In a type 1 procedure, the cavernous sinus was dissected epidurally and retracted posteriorly. In a type 2 procedure, the anterolateral portion of the cavernous sinus was excised and the carotid artery preserved. In a type 3 procedure, the entire cavernous sinus including the carotid artery was resected. RESULTS: Of 25 malignant skull base tumors, type 1 procedures were used in 7, type 2 in 5, and type 3 in 3. For these 15 patients, 7 are in good condition without evidence of tumor recurrence, 2 are alive with tumor, 4 died of tumor recurrence, and 2 died of complications. Two-year survival rates were 54% for patients with a type 1 procedure, 100% for type 2, and 33% for type 3. CONCLUSIONS: Using our techniques, we could totally excise tumors impinging on the cavernous sinus. However, the advanced tumors requiring resection of the entire cavernous sinus with the carotid artery are associated with major morbidity and mortality.