Complete resection of the cavernous sinus-indications and technique.

OBJECTIVE: To describe surgical management with complete resection of patients with recurrent benign or malignant lesions involving the cavernous sinus after standard therapy with an emphasis on surgical indications and surgical technique.
METHODS: Patients who underwent complete resection of the cavernous sinus for recurrent or progressive tumors or progressive infection were retrospectively identified.
RESULTS: Of 8 patients who fit the inclusion criteria, 7 had recurrent or progressive tumor after previous surgery or radiation therapy or both, and 1 had progressive fungal infection (mucormycosis) despite medical treatment. Mean overall survival was 2.9 years, and 4 patients experienced complications, including 2 who died in the perioperative period.
CONCLUSIONS: Complete cavernous sinus resection is an option for patients with progressive or recurrent tumors after standard therapy. Extended survival can occur in some patients. The risks of surgery are considerable, and the underlying disease, age of the patient, and associated comorbidities should be considered when making the decision to operate. Surgery should be considered for oncologic resection of malignant tumors with limited extracranial disease or in patients with recurrent or progressive benign tumors. A key decision involves whether revascularization should be used with resection. Revascularization has been used in patients with inadequate vascular reserve as measured by balloon occlusion testing and patients with benign tumors and longer life expectancy.