Defining the Limits of the Anterior Wall of the Cavernous Sinus Through an Endoscopic View: Cadaveric Anatomical Study

Overview

Journal Surg Neurol Int

Specialty Neurology

Date 2023 Aug 10

PMID 37560597

Authors

Marcos V Sangrador-Deitos

Gerardo Y Guinto-Nishimura

Luis A Rodriguez-Hernandez

Alvaro Campero

Affiliations

Soon will be listed here.

Abstract

Background: The anterior wall of the cavernous sinus (CS) represents an important landmark for endoscopic surgery that although mentioned before, no precise anatomical boundaries have been described. We describe the anatomical landmarks that delimit the anterior wall of the CS, emphasizing its importance as a reference for accessing the CS through endoscopic approaches.

Methods: Six adult cadaveric heads fixed with formaldehyde and injected with colored silicone were studied. In all the heads, an endonasal endoscopic approach to the sellar and parasellar regions was performed and the anatomy of the anterior wall of the CS was studied.

Results: Four consistent anatomical landmarks that mark the limits of the anterior wall of the CS were found in all the specimens: anterosuperiorly, the lateral opticocarotid recess; posterosuperiorly, the medial opticocarotid recess; anteroinferiorly, the inferior part of the maxillary strut; and posteroinferiorly, the superolateral angle of the clival recess.

Conclusion: It is of paramount importance to recognize the anatomical landmarks that define the limits of the anterior wall of the CS to achieve a safe access to this so complex region.

References

Labib M, Prevedello D, Carrau R, Kerr E, Naudy C, Abou Al-Shaar H . A road map to the internal carotid artery in expanded endoscopic endonasal approaches to the ventral cranial base. Neurosurgery. 2014; 10 Suppl 3:448-71. DOI: 10.1227/NEU.0000000000000362. View

Kassam A, Prevedello D, Carrau R, Snyderman C, Gardner P, Osawa S . The front door to meckel's cave: an anteromedial corridor via expanded endoscopic endonasal approach- technical considerations and clinical series. Neurosurgery. 2009; 64(3 Suppl):ons71-82. DOI: 10.1227/01.NEU.0000335162.36862.54. View

Yasuda A, Campero A, Martins C, Rhoton Jr A, Ribas G . The medial wall of the cavernous sinus: microsurgical anatomy. Neurosurgery. 2004; 55(1):179-89. DOI: 10.1227/01.neu.0000126953.59406.77. View

Peris-Celda M, Kucukyuruk B, Monroy-Sosa A, Funaki T, Valentine R, Rhoton Jr A . The recesses of the sellar wall of the sphenoid sinus and their intracranial relationships. Neurosurgery. 2013; 73(2 Suppl Operative):ons117-31. DOI: 10.1227/NEU.0000000000000184. View

Alikhani P, Sivakanthan S, van Loveren H, Agazzi S . Paraclival or Cavernous Internal Carotid Artery: One Segment but Two Names. J Neurol Surg B Skull Base. 2016; 77(4):304-7. PMC: 4949067. DOI: 10.1055/s-0035-1568870. View

Campero A, Campero A, Martins C, Yasuda A, Rhoton Jr A . Surgical anatomy of the dural walls of the cavernous sinus. J Clin Neurosci. 2010; 17(6):746-50. DOI: 10.1016/j.jocn.2009.10.015. View

Catapano G, Sgulo F, Laleva L, Columbano L, Dallan I, de Notaris M . Multimodal use of indocyanine green endoscopy in neurosurgery: a single-center experience and review of the literature. Neurosurg Rev. 2017; 41(4):985-998. PMC: 6133047. DOI: 10.1007/s10143-017-0858-4. View

Fernandez-Miranda J, Gardner P, Rastelli Jr M, Peris-Celda M, Koutourousiou M, Peace D . Endoscopic endonasal transcavernous posterior clinoidectomy with interdural pituitary transposition. J Neurosurg. 2014; 121(1):91-9. DOI: 10.3171/2014.3.JNS131865. View

Zhang Q, Wang Z, Guo H, Yan B, Wang Z, Zhao H . Direct Transcavernous Sinus Approach for Endoscopic Endonasal Resection of Intracavernous Sinus Tumors. World Neurosurg. 2019; 128:e478-e487. DOI: 10.1016/j.wneu.2019.04.182. View

10.

Schmidt R, Choudhry O, Raviv J, Baredes S, Casiano R, Eloy J . Surgical nuances for the endoscopic endonasal transpterygoid approach to lateral sphenoid sinus encephaloceles. Neurosurg Focus. 2012; 32(6):E5. DOI: 10.3171/2012.3.FOCUS1267. View

11.

Silveira-Bertazzo G, Martinez-Perez R, Carrau R, Prevedello D . Surgical anatomy and nuances of the expanded transpterygoid approach to the pterygopalatine fossa and upper parapharyngeal space: a stepwise cadaveric dissection. Acta Neurochir (Wien). 2020; 163(2):415-421. DOI: 10.1007/s00701-020-04551-y. View

12.

Truong H, Lieber S, Najera E, Alves-Belo J, Gardner P, Fernandez-Miranda J . The medial wall of the cavernous sinus. Part 1: Surgical anatomy, ligaments, and surgical technique for its mobilization and/or resection. J Neurosurg. 2018; 131(1):122-130. DOI: 10.3171/2018.3.JNS18596. View

13.

Fernandez-Miranda J, Zwagerman N, Abhinav K, Lieber S, Wang E, Snyderman C . Cavernous sinus compartments from the endoscopic endonasal approach: anatomical considerations and surgical relevance to adenoma surgery. J Neurosurg. 2017; 129(2):430-441. DOI: 10.3171/2017.2.JNS162214. View

14.

Kirtane M, Lall A, Chavan K, Satwalekar D . Endoscopic repair of lateral sphenoid recess cerebrospinal fluid leaks. Indian J Otolaryngol Head Neck Surg. 2013; 64(2):188-92. PMC: 3392343. DOI: 10.1007/s12070-011-0144-7. View

15.

Grewal S, Kurbanov A, Anaizi A, Keller J, Theodosopoulos P, Zimmer L . Endoscopic endonasal approach to the maxillary strut: anatomical review and case series. Laryngoscope. 2013; 124(8):1739-43. DOI: 10.1002/lary.24528. View

16.

Drazin D, Wang J, Alonso F, Patel D, Granger A, Shoja M . Intracranial Anatomical Triangles: A Comprehensive Illustrated Review. Cureus. 2017; 9(10):e1741. PMC: 5714398. DOI: 10.7759/cureus.1741. View

17.

Barges-Coll J, Fernandez-Miranda J, Prevedello D, Gardner P, Morera V, Madhok R . Avoiding injury to the abducens nerve during expanded endonasal endoscopic surgery: anatomic and clinical case studies. Neurosurgery. 2010; 67(1):144-54. DOI: 10.1227/01.NEU.0000370892.11284.EA. View

18.

Truong H, Sun X, Celtikci E, Borghei-Razavi H, Wang E, Snyderman C . Endoscopic anterior transmaxillary "transalisphenoid" approach to Meckel's cave and the middle cranial fossa: an anatomical study and clinical application. J Neurosurg. 2018; 130(1):227-237. DOI: 10.3171/2017.8.JNS171308. View

19.

Fernandez-Miranda J, Tormenti M, Latorre F, Gardner P, Snyderman C . Endoscopic endonasal middle clinoidectomy: anatomic, radiological, and technical note. Neurosurgery. 2012; 71(2 Suppl Operative):ons233-9. DOI: 10.1227/NEU.0b013e3182690b6b. View

20.

Labib M, Prevedello D, Fernandez-Miranda J, Sivakanthan S, Benet A, Morera V . The medial opticocarotid recess: an anatomic study of an endoscopic "key landmark" for the ventral cranial base. Neurosurgery. 2012; 72(1 Suppl Operative):66-76. DOI: 10.1227/NEU.0b013e318271f614. View