SURG-19. Extent of Surgical Resection is Associated with Overall Survival for Cavernous Sinus Hemangiomas

Cavernous sinus hemangiomas are rare, complex vascular lesions that may cause cranial neuropathies or hemorrhage. Surgical resection is often performed for symptom relief, yet the survival benefit of gross total resection (GTR) versus subtotal resection (STR) remains poorly defined. This study evaluates the association between extent of surgical resection—GTR vs. STR—and overall survival in patients with cavernous sinus hemangiomas. The National Cancer Database (NCDB) was queried for patients >18 years old diagnosed with cavernous hemangiomas (histology code 9121; behavior code 0) between 2004 and 2019. Patients were categorized by resection type (GTR vs. STR). A multivariable Cox proportional hazards analysis was performed, adjusting for age, sex, ethnicity, race, facility type, comorbidities, tumor size, adjuvant radiotherapy, and systemic therapy. A total of 598 patients met inclusion criteria, with 55.35% identifying as female. The majority were under age 60 (48.66% ≤40 years; 37.96% between 41–60), and 75.59% had a Charlson-Deyo Comorbidity score of 0. GTR was achieved in 356 patients (59.53%), while 242 (40.47%) received STR. Mean postoperative survival was approximately 24.30 months for GTR and 16.95 months for STR. On multivariate analysis, STR was associated with a 105% increased hazard of death compared to GTR (hazard ratio [HR] ≈ 2.05, p = 0.0361). Higher age (HR ≈ 1.05, p < 0.0001) and a comorbidity score ≥3 (HR ≈ 3.86, p = 0.0353) were also significant predictors of worse survival. Adjuvant radiotherapy was not significantly associated with survival. In patients with cavernous hemangiomas, GTR is associated with improved overall survival compared to STR. Our analysis supports maximal safe resection when feasible and highlights the importance of considering age and comorbidity burden in surgical decision-making.