Anatomy and Surgery of the Cavernous Sinus by Vinko V. Dolenc M.D., Ph.D. (auth.)

By Vinko V. Dolenc M.D., Ph.D. (auth.)

The selection of Harvey Cushing to go away basic surgical procedure and focus on the baby box of relevant anxious procedure surgical procedure was once looking back a landmark within the historical past of neurosurgery. His centred paintings, and likewise that of his colleague Walter Dandy, originated with the wishes of either pioneers to appreciate surgical anatomy and neurophysiology. the basic wisdom and surgical techni­ ques that they supplied turned the traditional of excellence for numerous generations of neurosurgeons; a lot in order that the overall trust used to be that the surgical innovations couldn't be more advantageous upon. Twenty-five to thirty years in the past microtechniques started to appear in a couple of surgical examine facilities, they have been then progressively utilized to medical neurosurgery and feature contributed to a brand new point of knowing in surgical anatomy and neurophysiology. we're now lucky to have a brand new commonplace of morbidity and mortality within the surgery of intrathecal aneurysms, angiomas, and tumors. it's been acknowledged that microneurosurgery used to be achieving its limits, in particular while treating lesions in and round the cavernous sinus and cranium base; these lesions infamous for involvement of the dural and extradural booths, with an inclination to infiltrate adjoining nerves and blood vessels. the risks of uncontrollable hemorrhage from the basal sinuses and post-operative CSF rhinorrhea seemed unsurmountable. The lateral features of the petro-clival area were of curiosity to a couple pioneering ENT surgeons and neurosurgeons however the cavernous sinus in so much respects has remained the ultimate unconquered summit.

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The anterior part of the paramedial triangle is shown under higher magnification. Its most important feature is that the IVth nerve and VI run over the IIIrd nerve before they enter the SOF. Deep in the center of this corner, the VIth nerve is seen embedded in "venous blood" Oculomotor trigone The triangular area of the oculomotor trigone, described previously [33], is located between the folds of the dura running between the ACP and the PCP, and medially with the fold of the dura running from the PCP to the ACP.

The Vth nerve together with the GG is elevated thereby exposing the lateral loop. In this figure, the entire course of the ICA from the foramen lacerum to the PCP, that is, from the lateral to the medial loop, can be traced. Since during surgery the Vth nerve cannot be elevated, different segments of the ICA must be approached through different triangles 57 Middle cranial fossa subregion leA (PL) GPN VI TA IV III PR DR leA (AL) Posterolateral (Glasscock's) triangle The greater superficial petrosal nerve (medial border), the posterior aspect of the GG and V3 (anterior border), and the line between the foramen spinosum and the arcuate eminence of the petrous bone (posterior border) [10].

15. In the anterior area of the anterolateral triangle a huge vein enters the lateral wall of the CS. The intense blue color of the lateral wall of the CS indicates that there is abundant blood between its layers Middle cranial fossa subregion 37 Middle cranial fossa subregion CV ACP IV Anterolateral triangle The lateral edge of VI (medial border), the medial edge of V2 (lateral border), and the anterolateral wall of the bony middle cranial fossa (anterior border). Through the anterolateral triangle the following structures are seen: the inferolateral aspect of the distal horizontal portion of the cavernous ICA, the dura and the anterior bony floor of the middle cranial fossa, the venous trabecular channels of the inferolateral CS, and the dura forming the inferior portion of the lateral wall of 38 The surgical triangles of the cavernous sinus Fig.

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