ArticleFrontiers in oncology2026
Case Report: transcavernous sinus resection of parotid carcinoma with perineural invasion to Meckel's cave and cavernous sinus.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Adenoid cystic carcinoma (ACC) of the salivary glands is a rare but aggressive malignancy known for perineural invasion (PNI), allowing tumor spread along cranial nerves to the skull base, Meckel's cave, and cavernous sinus. Cavernous sinus involvement has traditionally been considered inoperable due to the density of neurovascular structures. Recent advancements in skull base microsurgery and anatomical landmark-guided navigation have enabled radical tumor resection in carefully selected patients. Objective: To describe a tailored pretemporal extradural transcavernous skull base approach, combined with infratemporal fossa exposure, for radical resection of parotid ACC with extensive PNI into Meckel's cave and the cavernous sinus, emphasizing internal carotid artery (ICA) skeletonization, fascicular-level nerve dissection and repair, and precision bone work. Methods: A 54-year-old male presented with progressive left facial paralysis (House-Brackmann grade VI), trigeminal pain (V Results: Gross total resection was achieved with preserved integrity of the ICA and all cranial nerves. No new neurological deficits occurred; preexisting palsies remained stable. Pathology confirmed ACC with extensive PNI; immunohistochemistry was positive for Hematoxylin and eosin, B-catenin, CK-7, and S100. Postoperative MRI verified complete cavernous sinus tumor removal. The patient recovered well and was referred for adjuvant stereotactic radiotherapy. Conclusion: This case demonstrates that even extensive cavernous sinus invasion by parotid ACC can be safely addressed with curative intent through precision-based microsurgery. A modified Dolenc approach with limited bone work and infratemporal extension enables maximal resection while preserving function. Strategic reconstruction optimizes safety for adjuvant radiation. This report adds to the growing evidence supporting aggressive yet function-preserving surgical management of malignant skull base tumors in multidisciplinary oncology programs.
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