• Robert C Rennert, Kristine Ravina, Ben A Strickland, Joshua Bakhsheshian, Vance L Fredrickson, and Jonathan J Russin.
• Department of Neurological Surgery, University of California-San Diego, San Diego, California, USA.
• World Neurosurg. 2018 Nov 1; 119: 89-96.

BackgroundComplete cavernous sinus resection has been described for patients with malignant or recurrent cavernous sinus tumors without other therapeutic options but has been associated with high morbidity and mortality rates. We reviewed the complications associated with complete cavernous sinus resection to gain insights for future complication avoidance.MethodsA retrospective analysis of a prospective, single-institution database was performed to identify patients who had undergone complete cavernous sinus resection from July 2014 to October 2017. Patient- and disease-specific data, surgical complications, and clinical outcomes were recorded.ResultsTwo male patients underwent complete cavernous sinus resection (aged 60 and 47 years) for recurrent maxillary tumors with secondary cavernous sinus extension. Revascularization was performed based on balloon test occlusion (BTO) results, with extracranial-to-intracranial bypass performed in 1 patient with a concerning hemispheric flow pattern found during BTO. Vascularized free flaps were used in both patients to assist with closure of the resulting skull base defect. Three complications related to surgery occurred in 1 patient (thigh hematoma, recurrent cerebrospinal fluid leak, and meningitis). One patient died of pneumonia approximately 2 weeks postoperatively, and the other experienced an acceptable neurologic and oncologic outcome.ConclusionsDespite the high peri- and postoperative risks, complete cavernous sinus resection can be considered for select patients with tumors involving the cavernous sinus without other treatment options. Familiarity with cerebral bypass and free flap reconstruction of skull base defects is critical for complication avoidance and management.Copyright © 2018 Elsevier Inc. All rights reserved.

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