Microsurgical techniques and tumor control in cavernous sinus meningiomas

This is the authors' abstract. We don't add key points for this paper.

Meningiomas are the most common tumors of the cavernous sinus (CS) and are one of the most challenging/formidable tumors to operate on due to the complex anatomy and rich neurovascular contents of the space. Parkinson's initial approach to this surgical “no man's land” triggered the interest in the microsurgical removal of tumors within this region over the next three decades. However, this initial enthusiasm to attempt complete removal of meningiomas has been met with exceedingly high surgical morbidity, especially cranial nerve palsies, and considerable mortality, predominantly due to vascular complications. The later introduction of radiosurgery and its excellent tumor control rate and minimal complications has allowed surgeons to select less invasive approaches such as primary radiosurgery or partial resection followed by radiosurgery. The authors aim through this work to discuss the relevant microsurgical anatomy, evolution of approaches, and techniques of CS meningioma excision including the endoscopic endonasal approach. We discuss the available alternatives and adjuvant management options, proposing an up-to-date multimodality treatment algorithm to optimize outcomes.