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 choice of Harvey Cushing to go away normal surgical procedure and focus on the baby box of relevant fearful method surgical procedure was once on reflection a landmark within the historical past of neurosurgery. His targeted paintings, and in addition that of his colleague Walter Dandy, originated with the wishes of either pioneers to appreciate surgical anatomy and neurophysiology. the elemental wisdom and surgical techni­ ques that they supplied grew to become the normal of excellence for a number of generations of neurosurgeons; quite a bit in order that the overall trust used to be that the surgical thoughts couldn't be superior upon. Twenty-five to thirty years in the past microtechniques began appearing in a couple of surgical study 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 surgical operation of intrathecal aneurysms, angiomas, and tumors. it's been acknowledged that microneurosurgery used to be attaining its limits, specifically whilst treating lesions in and round the cavernous sinus and cranium base; these lesions infamous for involvement of the dural and extradural cubicles, with a bent to infiltrate adjoining nerves and blood vessels. the hazards of uncontrollable hemorrhage from the basal sinuses and post-operative CSF rhinorrhea seemed unsurmountable. The lateral facets 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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By laterally drilling the bone of the middle fossa additional space is gained for a better lateral approach. The lateral triangle of the left CS is shown in Figs. 21-25. 50 The surgical triangles of the cavernous sinus Fig. 22. The lateral triangle is much smaller than the anterolateral triangle. It is completely filled with "venous blood". Through the transparent blue venous injection, the arterial branch is visible. Note that V3 is much shorter than V2 and that the GG is much closer to the foramen ovale than to the foramen rotundum Sl Middle cranial fossa subregion FO PR MM DR OA FR IV III leA 52 The surgical triangles of the cavernous sinus Fig.

46 The surgical triangles of the cavernous sinus Fig. 20. Through this triangle a large segment of the VIth nerve can be seen. For better visualization of the VIth nerve, the leA and the sympathetic fibers running from the leA to the VIth nerve and hence to VI, it is necessary to retract VI medially. The fibrous covering of the bone is the direct continuation of the dura which runs from the apex of the petrous bone, forms the lateral ring around the leA medial to the foramen lacerum, and proceeds further anteriorly to cover the bone.

The "venous pool" in the sinus as well as the arterial branches supplying the nerves are shown ubregion nial fossa S M id d le cra FR FT VI PR OA DR GG VJ IV 45 III leA. 46 The surgical triangles of the cavernous sinus Fig. 20. Through this triangle a large segment of the VIth nerve can be seen. For better visualization of the VIth nerve, the leA and the sympathetic fibers running from the leA to the VIth nerve and hence to VI, it is necessary to retract VI medially. The fibrous covering of the bone is the direct continuation of the dura which runs from the apex of the petrous bone, forms the lateral ring around the leA medial to the foramen lacerum, and proceeds further anteriorly to cover the bone.

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