Extradural disconnection of the cavernous sinus with preservation of the internal carotid artery: indication and technique

Abstract

Background: Extradural disconnection of the cavernous sinus (CS) with preservation of the internal carotid artery (ICA) is indicated for aggressive and recurrent tumors, in patients presenting loss of oculomotor function and non-functional circle of Willis.

Method: Extradural resection of the anterior clinoid process disconnects the CS anteriorly. The ICA is dissected in the foramen lacerum via extradural subtemporal approach. The intracavernous tumor is split and removed following the ICA. Bleeding control of the inferior and superior petrosal and intercavernous sinuses completes posterior CS disconnection.

Conclusion: This technique can be proposed for recurrent CS tumors and need of ICA preservation.

Keywords: Cavernous sinus; Cranial nerves; Hemangiopericytoma; Internal carotid artery; Meningioma; Oculomotor nerves; Skull base; Solitary fibrous tumor; Trigeminal nerve.