Endoscopic endonasal anatomical study of the cavernous sinus segment of the ophthalmic nerve

Dolci, Ricardo Landini Lutaif; Carrau, Ricardo L.; Buohliqah, Lamia; Zoli, Matteo; Filho, Paulo Moacir Mesquita; Lazarini, Paulo Roberto; Filho, Leo F. S. Ditzel; Prevedello, Daniel M.

doi:10.1002/lary.25050

Cited by 6 publications

(6 citation statements)

References 33 publications

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“…One of the variations found in this study has been previously reported: during its entire course on the lateral cavernous sinus wall, CNIV is found in intimate relation with CNVI, as though both structures were fused. This feature was found in 2 specimens (Table ; specimen 8, right side and specimen 4, left side), representing 10% of the total sample, similar to what was previously reported by Dolci et al Variation in the course of the trochlear nerve impacts the surface area of Parkinson's triangle, increasing its area when the nerve is located closer to the oculomotor nerve and decreasing it when closer to the ophthalmic nerve. Rhoton and others has also reported on variations of Parkinson's triangle (Table ).…”

Section: Discussionsupporting

confidence: 84%

“…To visualize the ophthalmic nerve, a slight mobilization of CNVI is necessary. Reaching this triangle endonasally requires drilling of the lateral wall of the sphenoid sinus and opening the first layer of dura, accessible ventrally (periosteal layer) . In this study, the anteromedial triangle presented an average surface area of 36.07 mm 2 (±4.15 mm 2 ), a similar finding to the results presented by Isolan et al of 36.26 mm 2 (±3.75 mm 2 ) but slightly different than those by Watanabe et al of 41.2 mm 2 (±15.4 mm 2 ).…”

Section: Discussionsupporting

confidence: 74%

“…In all specimens, the lateral wall was drilled thin and elevated from the underlying dura. Next, the ICA was exposed from the clinoid segment to the posterior genu (first genu), preserving the periosteal dura (first visible layer through the ventral perspective; Figure ) …”

Section: Methodsmentioning

confidence: 99%

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Endoscopic endonasal study of the cavernous sinus and quadrangular space: Anatomic relationships

et al. 2016

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Section: Discussionsupporting

confidence: 84%

Section: Discussionsupporting

confidence: 74%

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Endoscopic endonasal study of the cavernous sinus and quadrangular space: Anatomic relationships

et al. 2016

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“…Several anatomic studies have advocated the feasibility of the anteromedial triangle as the main endonasal entry for the MCF. 23 In the present study, the transposition of V2, expansion of the anteromedial triangle, and separation of the outer meningeal dural layer of the cavernous sinus from the temporal lobe dura led to a substantial increase in the surgical field. Additionally, the floor of the MCF was exposed.…”

Section: Discussionmentioning

confidence: 48%

“…The V1, which represents the upper limb of the anteromedial triangle, was estimated to be approximately 15 mm long from the gasserian ganglion to the SOF. 23 In contrast, the V2 is approximately 4 cm long from the gasserian ganglion to the PPF and can be extended in the IOF up to the ION. 12 However, V1, as part of the sensory triangle, protects the abducent and trochlear nerves running above and medial during the separation of the outer layers of the dura.…”

Section: Discussionmentioning

confidence: 95%

Endoscopic Endonasal Approach to the Lateral Wall of the Cavernous Sinus: A Cadaveric Feasibility Study

Amin

Fathy

Hussein

et al. 2018

Ann Otol Rhinol Laryngol

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Objective: A transcranial extradural approach to the middle cranial fossa (MCF) requires separation of the dural layers of the lateral wall of the cavernous sinus. The authors tested the feasibility of an endonasal approach for this separation. Methods: A cadaveric feasibility study was conducted on the sides of 14 dry skulls and 10 fresh cadaveric heads. An endonasal, transsphenoidal, transpterygoid approach was taken to the MCF. The maxillary struts and medial greater wing of the sphenoid below the superior orbital fissure were drilled with transposition of the maxillary nerve. The lateral cavernous dural layers were split at the maxillary nerve with separation of the temporal lobe dura and exposure of the MCF bony base. The integrity of the cranial nerves and inner and outer dural layers of the lateral cavernous wall was checked. Different measurements of bony landmarks were obtained. Results: The integrity of the dural layers of the lateral cavernous wall and the cranial nerves were preserved in 10 heads. The mean area of the bony corridor was 4.68 ± 0.97 cm 2 , the V2-to-V3 distance was 15.21 ± 3.36 mm medially and 18.21 ± 3.45 mm laterally, and the vidian canal length was 13.01 ± 3.06 mm. Conclusions: Endonasal endoscopic separation of the lateral cavernous dural layers is feasible without crossing the motor cranial nerves, allowing better exposure of the MCF.

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Expanded exposure and detailed anatomic analysis of the superior orbital fissure: Implications for endonasal and transorbital approaches

London

Chen

et al. 2020

Head & Neck

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This study aimed to ascertain the maximal exposure of the superior orbital fissure (SOF) afforded by combining endonasal and transorbital endoscopic approaches. Six cadaveric specimens (12 sides) were dissected using endonasal and transorbital endoscopic approaches to access the SOF. The order of the approaches was alternated in each specimen (eg, starting with an endonasal approach in one side followed by a transorbital exposure and reversing the order on the contralateral side). Maximal exposure of the SOF and its contents for individual and combined approaches were explored. The endonasal corridor provided adequate access to the inferomedial 1/3 of the SOF and including the proximal segments of cranial nerves (CN) III, V1 and VI. A transorbital approach was superior accessing the superolateral 2/3's of the SOF, including the superior ophthalmic vein, lacrimal nerve, and distal segment of the CN VI at the lateral aspect; the nasociliary nerve and divisions of CN III centrally; and the frontal nerve and CN IV at the dorsal aspect of levator palpebrae superioris. This study suggests that a combined endonasal and transorbital exposure of the SOF may be advantageous to address lesions in this challenging region.

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Endoscopic endonasal anatomical study of the cavernous sinus segment of the ophthalmic nerve

Abstract: NA.

Cited by 6 publications

References 33 publications

Endoscopic endonasal study of the cavernous sinus and quadrangular space: Anatomic relationships

Endoscopic endonasal study of the cavernous sinus and quadrangular space: Anatomic relationships

Endoscopic Endonasal Approach to the Lateral Wall of the Cavernous Sinus: A Cadaveric Feasibility Study

Expanded exposure and detailed anatomic analysis of the superior orbital fissure: Implications for endonasal and transorbital approaches

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