Surgical approach to cavernous sinus tumors

Due to the complex anatomy of the clivai region, total excision of tumors originating from the clivus had been impossible till 1970's. However, recent advances in surgical techniques and approaches made radical resection possible with negligible mortality. At the Department of Neurosurgery of Marmara University, a total of 27 patients were operated on for clivus tumors between the years of 1987-1996. Histologically 14 tumors were diagnosed to be meningiomas, 11 were chordomas and 2 were métastases. This presentation mainly deals with the evolution in the method of approach to the clivus meningiomas, in our department. Our first clivus meningioma was operated subtemporally, later two cases were operated on by suboccipital paramedian approach, and presigmoid retromastoid approach was the operation of choice for the last eleven cases. Pros and cons of each approach are discussed comparatively. Overall for all clivus meningioma cases, postoperative complications included 6th nerve paresis in 2 cases, lower cranial nerve findings in two cases, 7th nerve paresis in one case, hemiparesis in one case, hearing loss in one case, and hemiplegia in one case. By the end of the follow up period that ranged between 1 and 84 months (mean 28 months), patient's clinical grade according to Samu (1989) was good in 9 cases, moderate and bad in 2 cases each, with one patient being dead.