The cavernous sinus is a venous pathway located in the medial portion of the middle cranial fossa encircled by dural folds on either side of the sellar turcica. It contains important neurovascular structures including the cavernous segment of the carotid artery and its branches; the sympathetic plexus, the oculomotor, trochlear, and abducens cranial nerves; and ophthalmic division of the trigeminal nerve. Approaches to the cavernous sinus may be performed for basilar tip and ophthalmic segment carotid aneurysms, pituitary tumors, trigeminal neuromas, meningiomas, and other tumors in this region. Herein, we report what we believe to be the first description of surgery of the cavernous sinus.