Microsurgical anatomy of the arterial compartment of the cavernous sinus: analysis of 24 cavernous sinus

Abstract

-The cavernous sinus is a complex compartment situated in both sides of the sella turcica, being its microsurgical anatomy knowledge of fundamental importance when consider to approach surgically. We studied the arterial microanatomy of 24 cavernous sinus at the microsurgical laboratory, considering that in all the internal carotid artery were filled with colored latex. The meningohypophyseal trunk was present in 18 cases (75%) with its origin in intracavernous portion of the internal carotid artery. In relation to the 18 presented cases with meningohypophyseal trunk, 14 (77.7%) had a trifurcate and 4 (23.3%) had a bifurcate pattern. The tentorial artery was present in all. Its origin was observed, arising from the meningohypophyseal trunk in 17 (70.8%) and as an isolated artery in some extension of the intracavernous portion in 7 (29.1%). An accessory tentorial artery was found in one specimen. The dorsal meningeal artery was present in 22 cases (91.6%). Its origin was in the meningohypophyseal trunk in 17 cases (77.2%), arising from internal carotid artery in 4 cases (18.1%) and from inferior hypophyseal artery in one case (4.1%).The inferior hypophyseal artery was present in all cases, having its origin at the meningohypophyseal trunk in 16 cases (66.6%). In the remaining 8 cases (33.3%) the artery was found arising alone from the intracavernous portion also. The artery of the inferior cavernous sinus or inferolateral trunk was present in all cases and had its origin from internal carotid artery in its intracavernous segment. The McConnell's artery was not found in any cavernous sinus.KEY WORDS: cavernous sinus, microsurgical anatomy, internal carotid artery. M i c roanatomia do compartimento arterial do seio cavernoso e suas variações: análise de 24 seios cavernososRESUMO -O seio cavernoso é estrutura complexa localizada de cada lado da sela túrcica, sendo seu conhecimento microanatômico indispensável quando se considera abordar cirurgicamente esta região. Estudaramos em laboratório de microcirurgia a microanatomia dos componentes arteriais deste espaço em 24 seios cavernosos, sendo que em todos a artéria carótida interna estava preenchida com látex colorido. O tronco meningo-hipofisário esteve presente em 18 casos (75%). Quando ausente, as artérias constituintes deste tronco se originaram diretamente das artérias carótidas internas (ACIs) intracavernosas. Quando presente, em 14 casos (77,7%), estavam trifurcados e em 4 casos (23,3%) bifurcados. A artéria tentorial foi identificada em todos os casos, porém sua origem foi variada, ocorrendo no tronco meningohipofisário em 17 casos (70,8%) e na artéria carótida interna intracavernosa em 7 casos (29,1%). Em 1 caso verificou-se a presença de uma artéria tentorial acessória. A artéria meningéia dorsal estava presente em 22 casos (91,6%) e ausente em 2 casos (8,4%). Nos seios cavernosos onde a mesma foi identificada, a sua origem ocorreu no tronco meningo-hipofisário em 17 casos (77,2%), da ACI intracavernosa em 4 casos (18,1%) e da artéria hipofisária in...

Surgical outcomes using a medial-to-lateral endonasal endoscopic approach to pituitary adenomas invading the cavernous sinus

“…Deep to these structures lie the abducens nerve, carotid artery and its arterial branches to these intracavernous CNs, dorsal clivus, tentorium, pituitary gland, trigeminal ganglion, and foramen rotundum. 31 While numerous surgical approaches have been described to limit damage to these structures 21,22,40 , exposure and visualization, particularly to medially-situated lesions, is limited.…”

The Artery of Bernasconi and Cassinari: A Morphometric Study for Superselective Catheterization

“…1 The MHT arises lateral to the dorsum sellae at or just before the apex of the medial loop of the intracavernous carotid where it turns forward after leaving the foramen lacerum. 10 It divides near the roof of the cavernous sinus and typically gives rise to 3 branches: 1) the inferior hypophyseal artery that travels medially to supply the posterior pituitary capsule; 2) the dorsal meningeal artery that enters the dura of the posterior sinus wall and supplies the clival dura and sixth cranial nerve; and 3) the tentorial artery, also called the artery of Bernasconi and Cassinari.…”

“…It sends branches to the proximal portion of the third and fourth cranial nerve as well as medial portion of the gasserian ganglion, 1,12 and anastomoses with the branches of the tentorial artery from the opposite side. Similar findings were observed in our study.…”

“…1 It is important in neuroendovascular interventions for an entire spectrum of neoplasms and vascular lesions in the region of the tentorium cerebelli. Bernasconi and Cassinari 2 first reported the angiographic visualization of a tentorial artery supplying tentorial meningiomas.…”

“…Bernasconi and Cassinari 2 first reported the angiographic visualization of a tentorial artery supplying tentorial meningiomas. Since then, similar angiographic [3][4][5] and anatomic 1,6 observations have been published, but no morphometric study specific to the tentorial artery has been conducted. An anatomic study of this type is of utmost importance for imparting greater "precision" to the management of these lesions as well as in preventing inadvertent vascular compromise to normal structures, especially in this era of advanced superselective endovascular interventions.…”