Sphenoidal and cavernous sinus resection for tumor.

Malignant neoplasms as well as those with an aggressive locally invasive character involving the sphenoid sinus have been considered heretofore to be inoperable and incurable. Because of fear of entering the cavernous sinus, the proximity of the internal carotid artery laterally and the optic chiasm superiorly as well as the middle fossa contents, these patients were relegated to palliative regimens of irradiation and chemotherapy. As methods have been developed of managing hemorrhage from the cavernous sinus, exposure and control or bypass of the internal carotid artery and combined subcranial and intracranial resection, the frontiers of surgery in the sphenoid sinus have been advanced. We have resected eight patients with tumors involving the sphenoid sinus in whom the walls of the sinus were exenterated, portions of the cavernous sinus removed, the internal carotid artery skeletonized, anterior and middle fossa dura resected, and in a few the temporal lobe was excised. Follow-up ranges from six years to 10 months. There have been no perioperative deaths; one patient succumbed to general inanition with locally recurrent tumor at four months; the rest are all alive and well without evidence of tumor, with the exception of one patient. This patient has a local recurrence anteriorly from an inadequate margin due to a technical error, but there is no recurrence in the sphenoid sinus, the cavernous sinus or the middle cranial fossa.