Benefits and Pitfalls of Percutaneous Biopsy for Cavernous Sinus Tumors through the Foramen Ovale: Two Case Reports

Case 1, a 61-year-old female presented with paresthesia of her right upper lip. Computed tomography (CT) and magnetic resonance (MR) imaging with contrast material revealed an enhanced mass in the right Meckel's cave, which included the lateral and posterior parts of the cavernous sinus and surrounded the right internal carotid artery. To establish the best surgical strategy, a percutaneous biopsy through the foramen ovale was performed, and the histological examination indicated that the tumor was a transitional meningioma. We performed combined treatment with microsurgery and radiosurgery. Case 2, a 66-year-old female presented with paresthesia of the right side of her face. MR images with gadolinium revealed an abnormal enhanced mass at the right Meckel's cave, and a CT scan with a bone window showed a large foramen ovale in the right side. We performed a percutaneous biopsy using the same method, but this tumor was too hard to sample through the needle. Although this manipulation has the major advantage of establishing the best therapeutic strategy and avoiding unnecessary surgery, special care should be taken for hard tumors, especially for those aspirated by needle biopsy.