Commentary

Hemangiomas of the cavernous sinus are challenging lesions to resect when they exert significant mass effect on the cavernous sinus cranial nerves and internal carotid artery (ICA) with associated symptoms. Resection of these benign lesions should be considered. The authors entertained the possibility of a venous bypass. As indicated, the patient refused ICA angiography and a balloon occlusion test. I assume that the authors were not entertaining the possibility of carotid ligation. However, as evident in the actual surgical outcome, a bypass was unnecessary for the treatment of this lesion. If the lesion had been found to be unresectable at surgery, a bypass could have then been considered.

Death related to uncontrolled bleeding is a potential complication of removing cavernous sinus hemangiomas and has been reported. However, with contemporary neurosurgical techniques, such an outcome is rare both in our experience and in that of others. Preoperative embolization is seldom helpful for treating these lesions. Although the definitive benefit of radiosurgery is still unproven, smaller residual lesions that grow on serial imaging should be considered for this treatment. The authors should be congratulated for their excellent surgical outcome.