Decompressive Surgery for Small Cavernous Sinus Meningioma with Diplopia and Trigeminal Neuralgia: A Case Series

Cavernous sinus meningiomas are complex tumors that provide a real challenge to neurosurgeons. Aggressive surgical attempts have progressed in early 1990s by advances in microsurgical techniques. The excellent resection rates were often achieved at high functional cost. Stereotactic radiosurgery was given to small tumors with excellent tumor control. The authors are observing asymptomatic and small cavernous sinus meningiomas without any treatment. Recently, three patients with diplopia or trigeminal neuralgia underwent decompressive surgery. Bony decompression of the superior orbital fissure was done in the first patient with long-standing diplopia. In the second patient with medically refractory neuralgia, an anterior petrosal approach and intradural procedure for decompression of the trigeminal nerve were performed. A combined petrosal approach was done in the third patient with trigeminal neuralgia. In all three patients, preoperative symptoms improved immediately after surgery and there were no sequelae. Although the extent of resection is small, successful decompression of the oculomotor and trigeminal nerves is associated with postoperative improvement. Adjuvant radiation therapy is not planned yet. Close radiographic surveillance of the residual tumor is mandatory. The skull base approach that we have performed is familiar to trained neurosurgeons. When the patient and family understand that the tumor may remain, this decompressive surgery may be considered for symptomatic cavernous sinus meningiomas.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
05 February 2024