Introduction
Meningiomas are among the most common primary brain tumors, generally following a benign course, and account for about 40% of central nervous system tumors. These tumors can develop in various locations, depending on the origin of the altered meningothelial cells within the arachnoid layers. For this reason, there are numerous classification systems for meningiomas, with the most significant factors being tumor location and histological type. Cavernous sinus meningiomas are quite rare, occurring at a rate of approximately 2 cases per 100,000 people annually. The majority of tumors in the cavernous sinus are of meningeal origin.
Treatment options include microsurgical resection, with the goal of maximal tumor extirpation, although the delicate area of the cavernous sinus rarely allows for radical surgery. Other literature suggests that stereotactic radiosurgery (SRS) is an alternative method of treatment. This type of treatment is overtreated in processes with small tumor volume, which is not applicable in the presented clinical case due to the larger tumor volume.
Case Presentation
We present the case of a 49-year-old woman with a clinical presentation of double vision, difficulty focusing on objects, and mild ptosis of the left eyelid. Magnetic resonance imaging revealed a lesion in the left cavernous sinus, consistent with a cavernous sinus meningioma. The chosen treatment was microneurosurgical resection via a left pterygoid approach, combined with superior lateral orbitotomy and anterior clinoidectomy. Extradural access to the cavernous sinus allowed for a subtotal resection of the tumor.
Results: Postoperatively, the neurologic status worsened on the part of the oculomotor nerves, and the patient was discharged from the neurosurgery department with evidence of complete ophthalmoplegia.
Conclusion: The aim of this case report is to present the features of microsurgical access to the cavernous sinus, to compare the surgical treatment with radiosurgery, and the possibilities of postoperative complications.
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