Microsurgical management of benign lesions interior to the cavernous sinus: A case series

BACKGROUND Benign lesion interior to the cavernous sinus (CS) is very rare. OBJECTIVE In this series we found nonneoplastic lymphatic aggregation and osteoclastoma inside the CS which is very rare and probably not reported in literature. One interesting postoperative complaint of feeling of tickling down of warm water under the skin forehead was found in the patient of inflammatory disease of CS which is not reported in literature. Here we also describe our experiences of microsurgical management of series of benign lesions inside the CS. MATERIALS AND METHODS Benign mass originated from the content of CS or inner side of walls of CS, confirmed peroperatively were included in this series. Prospectively recorded data of microsurgical management was retrogradely studied. RESULTS Total number of patient was 12. Patient's age range was 30-60 years. Follow-up range was 60 months to 19 months. Three was nonneoplastic lesion (tuberculosis, inflammatory and nonneoplastic lymphoid infiltration). Among the 9 neoplastic lesions, two hemangiomas, two meningiomas, three 6th nerve schwannomas, one osteoclastoma and one epidermoid tumor. Middle cranial fossa-subtemporal extradural approach was used in 9 cases and in two cases extended middle fossa zygomatic approach. New postoperative 3rd nerve palsy developed in 5 cases all recovered completely except one. In seven patients 6th nerve palsy developed after operation; only one recovered. Postoperatively simultaneous 3rd, 4th and 6th nerve palsy developed in four cases. One interesting postoperative complaint of feeling of tickling down of warm water under the skin of left sided forehead was found in the patient of inflammatory disease of CS. Mortality was nil. Total resection was done in 9 cases. There was no recurrence till last follow-up. CONCLUSION Though decision for microsurgical removal of such lesions is not straight forward. Probably microsurgery is the best option in treating such benign lesions though it may associate with some permanent cranial nerve palsy.