Ophthalmic Complications of Cavernous Sinus Surgery

The cavernous sinus has long been thought a "never-never land." As recently as 1978, Jonathan Trobe in reviewing a series of six cavernous meningiomas and nine aneurysms suggested that "craniotomy is not recommended unless the visual pathways or brain stem are compromised by tumor or the patient suffers intolerable neuralgia." (Trobe 1978). Two years later in appending an editorial to an article, again on cavernous sinus lesions, Lawton Smith commented that "neither of the two lesions--meningioma or aneurysm--in the cavernous sinus should be considered surgical candidates--in most cases." (Smith 1980). Less than a decade later in discussing therapeutic approaches to lesions of the cavernous sinus, surgery was presented as the technique in many cases permits total removal of intracavernous lesions with the preservation of the internal carotid artery and avoidance of operative traumatization of the nerves. (Pemeczky 1988). This change in attitude was largely the result of several decades of improvement in the understanding of the anatomy of the cavernous sinus. The so-called "back door neighbor" (Photon 1990) of the orbit.