Endoscopic Endonasal Approach to Cavernous Sinus Hemangioma: A Report of Two Cases and Review of the Literature

Abstract

Cavernous sinus hemangiomas (CSHs) are rare, benign, slow-growing neoplasms within the cavernous sinus. Laterally located to these lesions, the cranial nerves and carotid artery are subject to injury during removal of hemangiomas through a transcranial route. Therefore, for surgi- cal management of cavernous sinus hemangiomas a medial corridor granted through an endoscop- ic endonasal approach may be less traumatic to the neurovascular bundle. Case-1 describes a 23-year old male who presented with intermittent blurred vision and very mild ptosis on the right side for two years before admission. Fundoscopic exam, visual acuity and perimetry tests were normal. With intense enhancement after contrast administration, both brain MRI and CT scan demonstrated an extra-axial mass in the right cavernous sinus. Case-2 presents a 59-year-old male, a known case of renal oncocytoma who underwent nephrec- tomy a year before, with chief complain of moderate intermittent headaches. Imaging study of the brain by MRI revealed a sellar mass. Near-total resection for case-1 and gross total resection for case-2 were performed through the an extended endoscopic endonasal approach. We report two cases of near-total and gross total resection of CSHs via an extend- ed endoscopic endonasal approach substantiating advances in minimal access neurosurgery to the treatment of such grim lesions of an intricate vicinity of the skull base. At the same time, we focus to review extensively the growing yet heterogenous literature of the past twenty years on the broached topic. The evolution of extended endoscopic endonasal approach over the past two decades changes the dynamism of the surgical practices steeped in tradition and provides a safer alternate route for preserving cranial nerves of this anatomic region.