Microsurgery Of Cavernous Sinus Tumors And Functional Outcome Of Eyeball Movement Nerves

Objective To summarize the experience and effect of microsurgery of cavernous sinus tumors, and investigate factors that influence the operation outcomes and postoperative function of eyeball movement nerves(Ⅲ,Ⅳ,Ⅵcranial nerves), in order to guide the operations of cavernous sinus tumors in future.Methods Retrospectively analyze 164 consective cases of cavernous sinus tumors admitted in the Skull base and Brain stem department of Tiantan hospital from August, 1993 to September, 2006 by telephone or outpatient clinic. All the patients had undergone tumors surgery. The information of patients includes the general condition, postoperative eyeball movement, neuroimage, and recurrence, et al. All data was input into the database set up by Epidata3.02. We summarized and analysed items as follow: sexuality, age, duration of disease, first sign, prior surgery, prior radiotherapy, preoperative and postoperative nervous function, tumor type, location, volume, acompanying diseases, surgical approach, margin of tumor, blood supply, adherence, origin, intraoperative nerve preservation, tumor resection grade, postoperative early complication, postoperative recovery, mortality. The statistical analysis was performed with SPSS12.0.Results Of 164 cavernous sinus tumors patients, 131 patients have been followed up, including 41 male(31.3%) and 90 female(68.7%), 13-70 years old with average of 44.05±1.06 years. Duration of disease was from 1 to 601 months, the average was 55.02±7.16 months. 7 cases have prior radiotherapy. 20 cases have prior surgeries. 11 cases have prior radiotherapy and surgeries. 46 cases (35.1%) showed local cranial nerves founctional disorders as the first sign, while 85 cases(64.9%) showed high ICP symptoms. There are 62 meningiomas (47.3%), 19 schwanomas (14.5%), 26 cavernomas (19.8%), and others (18.3%). 18 cases were given radiotherapy. During followup, 5 cases died and 5 recurred and 3 were given repeated operation. Eyeball movement nerves founctionally preserved in 87.6% cases.Conclusion Prior surgery, prior radiotherapy, tumor location, volume, tumor type, duration, adherence, origin have close correlations with postoperative nerve function and tumor resection grade. First sign and eyeball movement conditions are closely related with postoperative nerve function. Patients with cranial nerves disorders as first sign get worse function of eyeball movement nerves. Eyeball movement nerves'functions deteriorate after operation, but recover quickly between 2-6months postoperatively. Some cases'functions still keep recovering 1 year after operation, but the majority keep steady 2 years after surgery. Biglan ocular muscles grading system is better than KPS to show the condition and change of neural functions of patients with cavernous sinus tumors.