Microsurgical Anatomy and Approaches to the Cavernous Sinus

Yasuda, Alexandre; Campero, Álvaro; Martins, Carolina; Rhoton, Albert L.; Oliveira, Evandro de; Ribas, Guilherme Carvalhal

doi:10.1227/01.neu.0000144208.42171.02

Cited by 106 publications

(117 citation statements)

References 52 publications

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“…The anterolateral approach relies on the pterion region as an entry point to access Meckel's cave [5,[14][15][16][17] . To reach the anterior part of the medial component of Meckel's cave, the anteromedial and the anterolateral triangles of the middle cranial fossa need to be traversed [15,17,18] .…”

Section: Discussionmentioning

confidence: 99%

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Nasal cavity-maxillary sinus-pterygopalatine fossa-Meckel’s cave: a preliminary anatomic study of an endoscopy-based operative approach

et al. 2009

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Objective To provide a new approach for the treatment of tumor in Meckel's cave, by dissecting adjacent structures of the nasal cavity-maxillary sinus-pterygopalatine fossa-Meckel's cave approach. Methods Fifteen adult cadaver heads (30 sides) were dissected and the correlated anatomic landmarks were observed, measured and analyzed in an operative route. Results The approach was divided into 3 steps: entering the maxillary sinus, the later pterygopalatine fossa and the final Meckel's cave. Safe access to Meckel's cave could be achieved by tracing the vidian neurovascular bundles and dissecting the quadrangular space (QS). The distances from the nasal columella to the apertura maxillaries, the sphenopalatine foramen, and the anterior foramen of the pterygoid canal were (44.08±2.61) mm, (64.83±2.42) mm, and (70.43±2.94) mm, respectively.The angles between the horizontal plate of the palatine bone and the link from nasal columella to apertura maxillaries, between the horizontal plate of the palatine bone and the link from nasal columella to sphenopalatine foramen were (38.10±2.46)° and (26.15±2.26)°, respectively. Conclusion The endoscopic approach of transnasal maxillary sinus-pterygopalatine fossaMeckel's cave (ENMPA) is a safe and direct way to access Meckel's cave, and could be employed for the treatment of tumor in Meckel's cave.

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Section: Discussionmentioning

confidence: 99%

“…To reach the anterior part of the medial component of Meckel's cave, the anteromedial and the anterolateral triangles of the middle cranial fossa need to be traversed [15,17,18] . This approach is applied mainly to remove the intracranial trigeminal schwannomas (TS) predominantly located in the middle fossa.…”

Section: Discussionmentioning

confidence: 99%

Nasal cavity-maxillary sinus-pterygopalatine fossa-Meckel’s cave: a preliminary anatomic study of an endoscopy-based operative approach

et al. 2009

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“…Reports have consecutively emphasized that the surgical exploration of the cavernous sinus itself is often associated with cranial nerve deficits or excessive bleeding, even when meticulous microsurgical dissection within the cavernous sinus was performed. Although techniques to approach the cavernous sinus have been extensively described 2,6,16 , the visualization of intracavernous cranial nerves and the carotid artery requires elaborate extradural bone removal and hazardous dissection between the two dural layers of the cavernous sinus.…”

Section: Discussionmentioning

confidence: 99%

“…The cavernous sinus, located at the central cranial base, and the neighbouring Meckel's cave represent a complex anatomical region, which is surrounded by dural walls containing important neurovascular structures 1,2 . It may harbour various neoplastic and vascular lesions of different origin, which are increasingly found in an early stage of growth because of the advent and availability of modern imaging studies 3 .…”

Section: Introductionmentioning

confidence: 99%

Image-guided resection of small lesions in the cavernous sinus and Meckel's cave

Nakamura

Krauss

2010

European Journal of Surgical Oncology (EJSO)

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Objective: The microsurgical resection of tumors or vascular lesions in the cavernous sinus and the neighbouring Meckel's cave has been considered as hazardous because of often associated cranial nerve morbidity. Despite increasing consent that many of such tumors should not undergo surgical therapy, the cavernous sinus and Meckel's cave may harbour small lesions of various origin, which are amenable for surgical resection. Surgery in this anatomical area needs a well directed approach. In this setting, neuronavigational guidance may provide a useful tool. We report on a series of patients operated on guided by neuronavigation. Methods:Five patients underwent a pterional approach for microsurgical resection. The procedures were planned and assisted by a pointer based neuronavigation system (Medtronic Stealth Station). Pathological entities included schwannoma, epidermoid, cavernoma and capillary hemangioma. Three lesions were located in the Meckel's cave and two lesions in the cavernous sinus. Results:Intraoperative guidance by neuronavigation appeared to be particularly instrumental in identification of the appropriate site of dural incision over the target region for microsurgical resection. Except of a mild increase of facial hypesthesia in one patient, there were no new cranial nerve deficits. In three patients, preoperative symptoms improved immediately after surgery. Conclusion:The surgical resection of small tumors or vascular lesions within the Meckel's cave or cavernous sinus is facilitated by neuronavigational guidance with sufficient intraoperative reliability and safety. In consideration of well known anatomical landmarks, targeted entry into the cavernous sinus or Meckel's cave directed by neuronavigation enables a tailored approach for microsurgical resection.

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“…Additionally, the oculomotor nerve on its way to the cavernous sinus assumes a very close position in relation to the carotid artery, distancing itself from the latter by a few millimetres, in such a way that just the cerebrospinal fluid and arachnoid membrane in the subarachnoid space separates the two [21,22]. Large aneurysms of the supraclinoid internal carotid segment, which grow downwards, might compress the parasympathetic fibres which run in the dorso-medial aspect of the oculomotor nerve.…”

Section: Discussionmentioning

confidence: 99%

Cluster headache and intracranial aneurysm

et al. 2007

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In the present study we describe the cases of two patients with cluster-like headache related to intracranial carotid artery aneurysm. One of these patients responded to verapamil prescription with headache resolution. In both cases the surgical clipping of the aneurysm resolved the cluster pain. These findings strongly suggest a pathophysiological link between the two conditions. The authors discuss the potential pathophysiological mechanisms underlying cluster-like headache due to intracranial carotid artery aneurysm.

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Microsurgical Anatomy and Approaches to the Cavernous Sinus

Cited by 106 publications

References 52 publications

Nasal cavity-maxillary sinus-pterygopalatine fossa-Meckel’s cave: a preliminary anatomic study of an endoscopy-based operative approach

Nasal cavity-maxillary sinus-pterygopalatine fossa-Meckel’s cave: a preliminary anatomic study of an endoscopy-based operative approach

Image-guided resection of small lesions in the cavernous sinus and Meckel's cave

Cluster headache and intracranial aneurysm

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