Cavernous sinus hemangiomas: stereotactic radiosurgery as gold standard, with robotics and AI on the horizon

Cavernous sinus hemangiomas (CSHs) are rare, highly vascular tumors of the skull base where conventional surgery carries substantial morbidity. Stereotactic radiosurgery (SRS) has emerged as the gold standard, offering >90% local control and substantial tumor shrinkage with minimal cranial nerve deficits. Hypofractionated and staged approaches further extend safety in complex cases. Robotics and artificial intelligence (AI) represent promising adjuncts, with robotics improving surgical access in select cases and AI models supporting intraoperative accuracy and outcome prediction. However, adoption is limited by technical constraints, sparse clinical evidence, and lack of validated AI algorithms. While SRS remains the primary treatment, future integration of robotics and AI requires multicenter validation, standardized reporting, and technological refinement to ensure safe translation into clinical practice.