Anatomy of meckel’s cave and the trigeminal ganglion: anatomical landmarks for a safer approach to them

Arslan, Mehmet; Deda, Haluk; Avcı, Emel; Elhan, Alai̇tti̇n; Tekdemi̇r, İbrahi̇m; Rs, Tubbs; Sılav, Gökalp; Yılmaz, Engin; Mk, Baskaya

doi:10.5137/1019-5149.jtn.5213-11.1

Cited by 22 publications

(42 citation statements)

References 13 publications

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“…First, duplicates (n = 89) and non-English abstracts (n = 25) were removed; thereafter, 157 abstracts were screened for relevance resulting in the full-text evaluation of 112 articles. Subsequently, 75 articles were identified for our qualitative synthesis and included case reports (n = 21) , cadaveric studies (n = 32) [3,6,7,10,13,, clinical articles (n = 16) [2,5,8,9,16,[61][62][63][64][65][66][67][68][69][70][71], review of the literatures (n = 3) [72][73][74], as well as technical notes (n = 2) [75,76] and a radiological manuscript (n = 1) [77]. These outlined articles were published between February 1978 and November 2018.…”

Section: Resultsmentioning

confidence: 99%

“…When approaching from the extradural space, elevation of the middle fossa dura is limited medially due to attachment to the V 3 -Branch and the CS [6]. Furthermore, the meningeal medial artery at the foramen spinosum and V 3 at the foramen ovale can be identified before exiting the skull base [6]. Skeletonizing the superior orbital fissure and foramen rotundum and ovale will help delineate the plane of dura elevation [56].…”

Section: Anterolateral and Lateral Approachesmentioning

confidence: 99%

“…External approaches have been historically applied to access this region [6][7][8][9]. The introduction of rod-lensendoscopes allowed for minimal-access routes to the sellar and parasellar region affording exposure of the anterolateral and inferior portion of Meckel's cave [5], thus improving cosmetic results and potentially decreasing surgical morbidity [10].…”

Section: Introductionmentioning

confidence: 99%

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Access to Meckel’s cave for biopsies of indeterminate lesions: a systematic review

et al. 2020

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Accessing Meckel's cave (MC) is surgically challenging. Open approaches are complex and often correlated with high morbidity. Endoscopic approaches emerged in the last decade as feasible alternatives to open approaches, especially for sampling indeterminate lesions. This article first analyses available routes to approach Meckel's cave and presents furthermore an illustrative case. We conducted a systematic review and reported according to the guidelines for preferred reporting items for systematic reviews and meta-analyses (PRISMA). Various surgical approaches identified through the search are evaluated and discussed in detail. Additionally, we report on a case of woman with a lesion in MC, which was accessed through an endoscopic transpterygoid approach subsequently diagnosed as a diffuse large B cell lymphoma. Our search delivered 75 articles that included case reports (n = 21), cadaveric studies (n = 32), clinical articles (n = 16), review of the literatures (n = 3), as well as technical notes (n = 2) and a radiological manuscript (n = 1). Open routes included lateral approaches with many variations, mainly intra-and extradural pterional approaches and anterior petrosal, as well as a retrosigmoid intradural suprameatal and a lateral transorbital approach. Endoscopically, MC was reached via approaches that included transpterygoid, transorbital or infraorbital fissure routes. Percutaneous approaches, e.g. through the foramen ovale, were also described. Multiple surgical approaches to MC are currently available. Their different characteristics as well as individual patient factors, such as clinical history and the localization of the disease, have to be considered when choosing a surgical corridor. Studies included in this review highlight the endonasal endoscopic transpterygoidal technique as an excellent corridor for biopsies in the ventral MC.

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Section: Resultsmentioning

confidence: 99%

Section: Anterolateral and Lateral Approachesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Access to Meckel’s cave for biopsies of indeterminate lesions: a systematic review

et al. 2020

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“…The choice of approach depends on the location, the type of pathology, anatomical relationships, familiarity and experience of the surgeon. In accessing the TC through the anterolateral and lateral approach, the foramen ovale with the mandibular division are the most important landmarks for identification of the TC (Arslan et al, 2012). The length of the mandibular division extends from the TG to the foramen ovale.…”

Section: Discussionmentioning

confidence: 99%

Trigeminal Cave and Ganglion: An Anatomical Review

2013

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SUMMARY:The trigeminal cave (TC) is a special channel of dura mater, which extends from the posterior cranial fossa into the posteromedial portion of the middle cranial fossa at the skull base. The TC contains the motor and sensory roots of the trigeminal nerve, the trigeminal ganglion (TG) as well as the trigeminal cistern. This study aimed to review the anatomy of the TC and TG and determine some parameters of the TC. The study comprised two subsets: A) Cadaveric dissection on 30 sagitally sectioned formalin fixed heads and B) Volume injection. We found the dura associated with TC arranged in three distinct layers. TC had relations with internal carotid artery, the cavernous sinus, the superior petrosal sinus, the apex of petrous temporal bone and the endosteal dura of middle cranial fossa. The mean volume of TC was 0.14 ml. The mean length and breadth of TG were 18.3 mm and 7.9 mm, respectively, mean width and height of trigeminal porus were 7.9 mm and 4.1 mm, respectively, and mean length of terminal branches from TG to point of exit within skull was variable. An understanding of the precise formation of the TC, TG, TN and their relations is important in order to perform successful surgical procedures and localized neural block in the region of the TC.

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“…Mean cave volumes are typically within the range of 0.2-0.6 mL, although volumes of up to 1.5 mL have been reported. Although such volume variability is, in part, related to systemic alterations in CSF dynamics (e.g., intracranial hypertension), the amount of fluid is normally sufficient to house the trigeminal ganglion [2,3]. The following is a case in which the presence of bilaterally miniscule Meckel's caves produced significant trigeminal neuralgia (TN), particularly in the V3 distribution.…”

Section: Introductionmentioning

confidence: 99%

Mandibular Myalgia and Miniscule Meckel’s Caves

Sundararajan

Loevner

Mohan³

2018

ORL

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Trigeminal neuropathy manifests as episodic sharp, shooting pain in the maxillofacial region. Contributory etiologies are myriad, ranging from central pathology affecting its origin in the brainstem to peripheral processes affecting their distal-most insertion sites. We present a case of bilateral hypoplastic Meckel’s caves in an adult patient leading to the clinical symptomology of trigeminal neuralgia. To the best of our knowledge, this is the only report of its kind highlighting this anatomic variant.

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Anatomy of meckel’s cave and the trigeminal ganglion: anatomical landmarks for a safer approach to them

Cited by 22 publications

References 13 publications

Access to Meckel’s cave for biopsies of indeterminate lesions: a systematic review

Access to Meckel’s cave for biopsies of indeterminate lesions: a systematic review

Trigeminal Cave and Ganglion: An Anatomical Review

Mandibular Myalgia and Miniscule Meckel’s Caves

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