| Objective: To discuss the selection of microsurgical approaches for the treatment of tumors in the cavernous sinus（CS）region,as well as the key points and experiences of each surgical approach.Materials and methods: A total of 43 patients with tumors in the cavernous sinus region admitted to the Department of Neuro-Oncology Surgery of the First Hospital of Bethune,Jilin University from January 2019 to September 2021 were screened according to the set inclusion criteria.The clinical data of these 43 patients were collected and retrospectively analyzed,and all cases were classified into three categories according to the imaging manifestations: 10 cases of tumors within the CS region,12 cases of tumors outside the CS region,and 21 cases of tumors inside and outside the communicating CS region.The tumors in this region were also classified according to the Sekhar method,and they were divided into two categories:18 cases of limited lesions and 25 cases of extensive lesions.Microsurgical resection was performed using different surgical approaches in all types of cases,and postoperative pathology was routinely performed and reviewed 3-6 months after surgery using conventional magnetic resonance imaging（MRI）scans of the head.Result: Among the 43 patients in this group,there were 23 meningiomas（23 / 43,53.5%）,14 trigeminal schwannomas（14 / 43,32.6%）,2 pituitary adenomas（2 / 43,4.7%）,2 craniopharyngiomas（2 / 43,4.7%）,1 nasopharyngeal carcinoma（1 / 43,2.3%）and 1 metastasis（1 / 43,2.3%）.Total resection was performed in 31 cases（31 / 43,72.1%）,subtotal resection in 9 cases（9 / 43,20.9%）,and partial resection in 3 cases（3 / 43,7.0%）.Among the 31 patients who underwent total resection,there were 16 meningiomas（16 / 31,51.6%）,12 trigeminal schwannomas（12 / 31,38.7%）,2 craniopharyngiomas（2 / 31,6.5%）,and 1 pituitary adenoma（1 / 31,3.2%）;Among the 9 cases of subtotal resection,there were 6 meningiomas（6 / 9,66.7%）,2 trigeminal schwannomas（2 / 9,22.2%）,and 1 pituitary adenoma（1 / 9,11.1%）;Among the three patients who underwent partial resection,there were 1 case of nasopharyngeal carcinoma（1 / 3,33.3%）,1 case of metastasis（1 / 3,33.3%）and 1 case of meningioma（1 / 3,33 / 3%）.Among the 9 cases of subtotal resection,there were 4 cases of tumors in CS area and 5 cases of tumors communicating inside and outside CS region.Except for 1 case of Meckel’s cystic tumor residue,the remaining 8 cases were residual in CS area and involved the internal carotid artery or sinus nerve.There was no significant progress in the above 9 cases during the follow-up period.Among the 3 cases of partial resection,there were 1 case of tumor in CS area and 2 cases of tumor outside CS area.Except that 1 case remained in CS area due to excessive texture,the other 2 cases were only for pathology.One case received radiotherapy and chemotherapy,and the other 2 cases received radiotherapy.There was no significant progress in the above 3 cases during the follow-up period.Conclusion: When formulating surgical strategies for patients with tumors in different CS region,while evaluating their clinical manifestations and imaging data,operators should also combine their own ideas,experience and habits to form a reasonable and appropriate individualized surgical scheme,and make flexible adjustments according to the specific conditions during the operation.In addition,we believe that lumbar cistern drainage is necessary in the operation of tumors in CS region.For limited tumors,pterion approach or infratemporal approach should be adopted according to the anterior and posterior position of the tumor,or frontotemporal orbito-zygomatic combined Dolenc approach can be adopted.For extensive tumors,frontotemporal orbito-zygomatic combined Dolenc approach was used.The frontotemporal orbito-zygomatic combined Dolenc approach under lumbar cistern drainage is the best choice for the treatment of tumors of the CS region,and should be improved according to the actual needs. |
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