Transclinoid-Transcavernous Approach to a Giant Cavernous Sinus Hemangioma: 2-Dimensional Operative Video

This surgical video demonstrates a transclinoid-transcavernous approach for the resection of a cavernous sinus hemangioma (Video 1). The patient is a 42-year-old woman who presented with headache and blurred vision. Magnetic resonance imaging (MRI) demonstrated an enhancing mass in the right-side cavernous sinus and sella. The patient underwent an orbitozygomatic craniotomy, extradural anterior clinoidectomy, and transcavernous approach for tumor resection. Removal of the orbital roof, lateral orbital wall, zygomatic arch, and anterior clinoid process with a high-speed drill was performed. The lateral wall of the cavernous sinus was opened via interdural dissection, and a large reddish tumor was encountered. The tumor was resected after circumferential dissection and coagulation. The cranial nerves III, IV, and V were found and preserved. The surgical cavity was closed with abdominal fat to prevent cerebral-spinal fluid leak. The bone flap was put back and fixed with titanium mesh, plates, and screws; the wound was closed in layers using sutures. The blurred vision relieved immediately after surgery. The patient suffered temporary right-side oculomotor nerve palsy, which was partially resolved after 6 months. There were no other complications. Final pathology was consistent with a cavernous sinus hemangioma. Postoperative MRI demonstrated near total resection except for a small piece of residual in the sella, which was stable in 6-month follow-up MRI scan without further treatment. The patient has been back to normal life and work.