Hemangiopericytoma of the Cavernous Sinus: Case Report and Surgical Strategy Reviewed

Introduction: We present a case of a 26-year-old male who had a presumptive diagnosis of a 2-cm right cavernous sinus meningioma. In 5 months, he developed a complete right sixth nerve and partial third nerve palsies, and the cavernous sinus mass increased in size by 1.5 cm.

Methods: A right pterional-transsylvian approach to the cavernous sinus was utilized. A reddish vascular tumor was encountered in the lateral wall of the cavernous sinus. Intraoperative pathology revealed hemangiopericytoma. A subtotal resection was performed, which included the laterally projecting mass and the lateral dura of the cavernous sinus. There were no new neurological deficits. Postoperative radiation therapy was delivered to the cavernous sinus.

Results: The immediate postoperative MRI revealed a residual right cavernous sinus mass of 2 cm. At 7 weeks, the patient experienced a complete resolution of his right third and sixth cranial nerve palsies. At 4 months, the MRI revealed minimal asymmetric enhancement.

Conclusions: A diagnosis of hemangiopericytoma should be entertained regarding a rapidly growing dural-based tumor. Given the favorable response to radiotherapy, when hemangiopericytomas involve the cavernous sinus, the surgical strategy should be aimed at safely debulking the tumor while preserving cranial nerve function.