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

Ali Fathi; Milad Rashidbeygi; Maryamalsadat Mousavi; Zahra Azizan; Seyed Mousa Sadrehosseini; Azin Tabari; Mehdi Zeinalizadeh

doi:10.18502/crcp.v7i3.11121

Ali Fathi School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Milad Rashidbeygi Department of Neurological Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Maryamalsadat Mousavi School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Zahra Azizan School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Seyed Mousa Sadrehosseini Otolaryngology, Head and Neck Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Azin Tabari Otolaryngology, Head and Neck Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Mehdi Zeinalizadeh Department of Neurological Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.

DOI: https://doi.org/10.18502/crcp.v7i3.11121

Keywords: Cavernous sinus; Hemangioma; Endoscopy; Endonasal; Tumor resection

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, forsurgi- 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 yearsbefore admission. Fundoscopic exam, visual acuity and perimetry tests were normal. With intense enhancement after contrastadministration, 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 ofmoderate 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 substantiatingadvances 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.