Endoscopic endonasal approaches to the cavernous sinus.
BACKGROUND
Surgical access to the cavernous sinus (CS) has proven a challenge for the skull base surgeon. Traditional approaches include the transcranial route, which broaches the lateral wall of the CS and has a high risk of cranial nerve weakness. A medial approach is more logical but the microscopic transsphenoidal approach has a restricted view. The endoscopic endonasal approach provides an alternative medial approach with improved visualization to that provided with the microscope. We describe our results using this approach for resection of CS tumors.


METHODS
A retrospective chart review was performed of all patients treated surgically at a tertiary care referral center between January 2004 and February 2011 with a purely endoscopic endonasal approach to the CS.


RESULTS
Out of 400 total endoscopic skull base cases, 41 (10.3%) involved the cavernous sinus. The most common approach was the transsphenoidal transsellar approach (31 patients, 75.6%). Other approaches included the tran-sethmoidal transsphenoidal parasellar (4 patients, 9.8%) and transmaxillary transpterygoidal (6 patients, 14.6%). The most common pathology was pituitary macroadenoma (24 patients, 58.5%). Gross total resection was achieved in 18 patients (43.9%). Cerebrospinal fluid (CSF) leak was not encountered in any patient postoperatively. Complications included 1 case of new postoperative VIth nerve palsy, 1 case of intraoperative hemorrhage, 2 cases of persistent diabetes insipidus, and 2 cases of sinusitis.


CONCLUSIONS
The endoscopic endonasal approach is a safe and effective option for tumor resection in the CS using a medial to lateral route for selected cases. Morbidity is low and a variety of reconstructive options are available.
Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY 10021, USA.
Roheen
R
Raithatha
Edward D
ED
McCoul
Graeme F
GF
Woodworth
Theodore H
TH
Schwartz
Vijay K
VK
Anand
D000328:Adult; D002426:Cavernous Sinus / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D009361:Neoplasm Invasiveness; D009383:Neoplasms, Vascular Tissue / Q000473:pathology / Q000601:surgery; D010256:Paranasal Sinuses / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery*; D016896:Treatment Outcome; D019043:Vascular Neoplasms / Q000601:surgery*