Endoscopic transnasal transsphenoidal approaches to the cavernous sinus: An anatomical dissection study and report on patients

Madeleine R. Schaberg, Jonathan Roth, Vijay K. Anand, Theodore H. Schwartz

Research output: Contribution to journalArticlepeer-review


Introduction: The neurovascular anatomy of the cavernous sinus severely limits surgical approaches for resection of tumors. Recent advances in endoscopic skull base surgery have defined surgical corridors to this challenging area. We present a series of cadaveric dissection using the endoscopic approach to the cavernous sinus and review the successful application of the endoscopic technique to eight patients. Study Design: Ten fresh injected cadaver heads were studied by the endoscopic approach to the cavernous sinus. A review of 275 cases of a prospectively acquired database of endoscopic transsphenoidal surgeries yielded 8 patients with cavernous sinus tumors who underwent endoscopic resection by senior authors (VKA and THS). These charts were retrospectively reviewed. Results: In our experience of 275 cases, 8 patients underwent endoscopic approaches to their cavernous sinus lesion. Pre-operative symptoms included; vision changes, pituitary dysfunction, and headaches. Five patients underwent resection of lesions extending from the sella and 3 underwent biopsy. Three required post-operative radiation and all had resolution of vision changes (excluding the biopsy only group). There were no carotid injuries or post-operative cerebrospinal fluid leaks. The pathology revealed adenomas, metastatic lymphoma and adenocarcinoma, hemangioma, neuroendocine tumor, and metastatic squamous cell carcinoma. Conclusions: Even though the cavernous sinus neurovascular structures pose a surgical challenge, this can be successfully overcome with image guidance, angled endoscopes, neurovascular studies and endoscopic doppler to map the carotid artery. This area is amenable to endoscopic resection in carefully selected cases.

Original languageEnglish
Pages (from-to)S123
Issue numberSUPPL. 3
StatePublished - Oct 2010
Externally publishedYes


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