scholarly journals Pure Endoscopic Lateral Orbitotomy Approach to the Cavernous Sinus, Posterior, and Infratemporal Fossae: Anatomic Study

2018 ◽  
Vol 80 (03) ◽  
pp. 295-305 ◽  
Author(s):  
Lili Laleva ◽  
Toma Spiriev ◽  
Iacopo Dallan ◽  
Alberto Prats-Galino ◽  
Giuseppe Catapano ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Lateral Wall ◽  
Middle Cranial Fossa ◽  
Direct Access ◽  
Petrous Apex ◽  
Anatomic Study ◽  
Anterior Clinoid Process ◽  
Lateral Orbitotomy ◽  
Before And After ◽  
Cranial Fossa

Objective The aim of this anatomic study is to describe a fully endoscopic lateral orbitotomy extradural approach to the cavernous sinus, posterior, and infratemporal fossae. Material and Methods Three prefixed latex-injected head specimens (six orbital exposures) were used in the study. Before and after dissection, a computed tomography scan was performed on each cadaver head and a neuronavigation system was used to guide the approach. The extent of bone removal and the area of exposure of the targeted corridor were evaluated with the aid of OsiriX software (Pixmeo, Bernex, Switzerland). Results The lateral orbital approach offers four main endoscopic extradural routes: the anteromedial, posteromedial, posterior, and inferior. The anteromedial route allows a direct route to the optic canal by removal of the anterior clinoid process, whereas the posteromedial route allows for exposure of the lateral wall of the cavernous sinus. The posterior route is targeted to Meckel's cave and provides access to the posterior cranial fossa by exposure and drilling of the petrous apex, whereas the inferior route gives access to the pterygopalatine and infratemporal fossae by drilling the floor of the middle cranial fossa and the bone between the second and third branches of the trigeminal nerve. Conclusion The lateral orbitotomy endoscopic approach provides direct access to the cavernous sinus, posterior, and infratemporal fossae. Advantages of the approach include a favorable angle of attack, minimal brain retraction, and the possibility of dissection within the two dural layers of the cavernous sinus without entering its neurovascular compartment.

Surgical Approaches to the Cavernous Sinus: A Microsurgical Study

Neurosurgery ◽  
1990 ◽  
Vol 26 (6) ◽  
pp. 903-932 ◽  
Author(s):  
Tooru Inoue ◽  
Albert L. Rhoton ◽  
Dan Theele ◽  
Margaret E. Barry
Keyword(s):  
Carotid Artery ◽  
Cavernous Sinus ◽  
Infratemporal Fossa ◽  
Lateral Wall ◽  
Middle Cranial Fossa ◽  
Surgical Approaches ◽  
Anterior Clinoid Process ◽  
Anatomic Variants ◽  
Cranial Fossa ◽  
Extradural Approach

Abstract The surgical approaches to the cavernous sinus were examined in 50 adult cadaveric cavernous sinuses using magnification of ×3 to ×40. The following approaches were examined: 1) the superior intradural approach directed through a frontotemporal craniotomy and the roof of the cavernous sinus: 2) the superior intradural approach combined with an extradural approach for removing the anterior clinoid process and unroofing the optic canal and orbit; 3) the superomedial approach directed through a supraorbital craniotomy and subfrontal exposure to the wall of the sinus adjacent to the pituitary gland; 4) the lateral intradural approach directed below the temporal lobe to the lateral wall of the sinus; 5) the lateral extradural approach for exposure of the internal carotid artery in the floor of the middle cranial fossa proximal to the sinus; 6) the combined lateral and inferolateral approach, in which the infratemporal fossa was opened and the full course of the petrous carotid artery and the lateral wall of the sinus were exposed and; 7) the inferomedial approach, in which the medial wall of the sinus was exposed by the transnasal-transsphenoidal route. It was clear that a single approach was not capable of providing access to all parts of the sinus. The intracavernous structures best exposed by each route are reviewed. The osseous relationships in the region were examined in dry skulls. Anatomic variants important in exposing the cavernous sinus are reviewed.

Endoscopic supraorbital extradural approach to the cavernous sinus: a cadaver study

2011 ◽  
Vol 114 (5) ◽  
pp. 1331-1337 ◽  
Author(s):  
Fuminari Komatsu ◽  
Mika Komatsu ◽  
Tooru Inoue ◽  
Manfred Tschabitscher
Keyword(s):  
Cavernous Sinus ◽  
Complex Structure ◽  
Lateral Wall ◽  
Middle Cranial Fossa ◽  
Cadaver Study ◽  
Minimal Invasiveness ◽  
Small Complex ◽  
Transcranial Approach ◽  
Cranial Fossa ◽  
Extradural Approach

Object The cavernous sinus is a small complex structure located at the central base of the skull. Recent extensive use of endoscopy has provided less invasive approaches to the cavernous sinus via endonasal routes, although transcranial routes play an important role in the approach to the cavernous sinus. The aims of this study were to evaluate the feasibility of the purely endoscopic transcranial approach to the cavernous sinus through the supraorbital keyhole and to better understand the distorted anatomy of the cavernous sinus via endoscopy. Methods Eight fresh cadavers were studied using 4-mm 0° and 30° endoscopes to develop a surgical approach and to identify surgical landmarks. Results The endoscopic supraorbital extradural approach was divided into 4 stages: entry into the extradural anterior cranial fossa, exposure of the middle cranial fossa and the periorbita, exposure of the superior cavernous sinus, and exposure of the lateral cavernous sinus. This approach provided superb views of the cavernous sinus structures, especially through the clinoidal (Dolenc) triangle. The lateral wall of the cavernous sinus, including the infratrochlear (Parkinson) triangle and anteromedial (Mullan) triangle, was also clearly demonstrated. Conclusions An endoscopic supraorbital extradural approach offers excellent exposure of the superior and lateral walls of the cavernous sinus with minimal invasiveness via the transcranial route. This approach could be an alternative to the conventional transcranial approach.

Lateral Orbitotomy Approach for Lesions Involving the Middle Fossa: A Retrospective Review of Thirteen Patients

Neurosurgery ◽  
2017 ◽  
Vol 80 (2) ◽  
pp. 309-322 ◽  
Author(s):  
Joseph D. Chabot ◽  
Paul A. Gardner ◽  
S. Tonya Stefko ◽  
Nathan T. Zwagerman ◽  
Juan Carlos Fernandez- Miranda
Keyword(s):  
Visual Acuity ◽  
Cavernous Sinus ◽  
Middle Cranial Fossa ◽  
Symptomatic Improvement ◽  
Middle Fossa ◽  
Total Resection ◽  
Patients Âgés ◽  
Lateral Orbitotomy ◽  
Patient Reported ◽  
Cranial Fossa

Abstract BACKGROUND: Classically used for treatment of orbital lesions, the lateral orbitotomy with cantholysis can be combined with a temporal craniectomy for lesions involving the middle cranial fossa. OBJECTIVE: To present a single-center experience with the lateral orbitotomy approach for lesions involving the middle fossa. METHODS: Twenty-five patients underwent lateral orbitotomies from April 2012 to July 2015. Excluding patients with solely intraorbital pathologies, 13 patients’ clinical and radiographic records were retrospectively reviewed. RESULTS: Signs/symptoms in the 13 patients (ages 28-81) included proptosis (69%), decreased visual acuity (31%), diplopia (54%), and afferent pupillary defect (69%). Pathologies were meningioma (8), esthesioneuroblastoma, lymphoma, chordoma, Ewing's sarcoma, and squamous cell carcinoma. Surgical goals were maximal safe resection in 8 patients, palliative debulking in 3 patients, and cavernous sinus biopsy in 2 patients. In 8 patients for whom maximal resection was the goal, 2 had gross total resection, while 6 had near-total resection. All patients (3) for whom palliation was the goal had symptomatic improvement. Both cavernous sinus biopsies obtained diagnostic tissue without complications. All patients with proptosis (n = 9) and diplopia (n = 7), and 2 of 4 patients with decreased visual acuity had improvement in their symptoms. No patient reported worsening of their symptoms. Mean follow-up was 12 mo (2-30 mo). Complications included oculorrhea (1), pseudomeningocele (2), transient ptosis (2), and forehead numbness (1). CONCLUSION: The lateral orbitotomy is a promising approach for carefully selected lesions with involvement of both the lateral orbit and middle cranial fossa. It provides minimally invasive access for biopsy, decompression, or resection.

EXTRADURAL TRANSCAVERNOUS APPROACH TO CAVERNOUS SINUS HEMANGIOMAS

Neurosurgery ◽  
2007 ◽  
Vol 60 (3) ◽  
pp. 483-489 ◽  
Author(s):  
Ashish Suri ◽  
Faiz U. Ahmad ◽  
Ashok K. Mahapatra
Keyword(s):  
Cavernous Sinus ◽  
Surgical Complication ◽  
Cranial Nerves ◽  
Lateral Wall ◽  
Middle Cranial Fossa ◽  
Middle Meningeal Artery ◽  
Anterior Clinoid Process ◽  
Complete Excision ◽  
Computed Tomographic ◽  
Rapid Decompression

Abstract OBJECTIVE Cavernous sinus hemangiomas (CSHs) are uncommon lesions and comprise fewer than 1% of all parasellar masses. Because of their location, propensity for profuse bleeding during surgery, and relationship to complex neurovascular structures, they are notoriously difficult to excise. CLINICAL PRESENTATION The authors describe their experience with seven cases of CSHs. Headache and visual impairment were the most common presenting complaints, followed by facial hypesthesia and diplopia. Computed tomographic scans revealed iso- to hyperdense expansile lesions in the region of the cavernous sinus and middle cranial fossa. Magnetic resonance imaging scans revealed hypo- to isointense lesions on T1-weighted images and markedly hyperintense lesions on T2-weighted images, with marked homogeneous enhancement after contrast administration. INTERVENTION All CSHs were treated by a purely extradural transcavernous approach. This involved reduction of sphenoid ridge, exposure of the superior orbital fissure, drilling of the anterior clinoid process, coagulation and division of the middle meningeal artery, and peeling of the meningeal layer of the lateral wall of the cavernous sinus from the inner membranous layer. The cranial nerves in the lateral wall of the cavernous sinus were exposed (Cranial Nerves III and IV, as well as V1, V2, and V3). The tumor was accessed through its maximum bulge through either the lateral or anterolateral triangle. The tumor was removed via rapid decompression, coagulation of the feeder from the meningohypophyseal trunk, and dissection along the cranial nerves. All but one patient had complete tumor excision. Transient ophthalmoparesis (complete resolution in 6–8 wk) was the most common surgical complication. CONCLUSION To our knowledge, we describe one of the largest series of pure extradural transcavernous approaches to CSHs. CSHs are uncommon but challenging cranial base lesions. The extradural transcavernous approach allows complete excision with minimal mortality or long-term morbidity.

The So-Called Cavernous Sinus: A Review of the Controversy and Its Implications for Neurosurgeons

Neurosurgery ◽  
1982 ◽  
Vol 11 (5) ◽  
pp. 712-717 ◽  
Author(s):  
John N. Taptas
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Cranial Nerves ◽  
Sella Turcica ◽  
Middle Cranial Fossa ◽  
Cranial Fossa ◽  
Base Of The Skull ◽  
Extradural Space

Abstract The so-called cavernous sinus is a venous pathway, an irregular network of veins that is part of the extradural venous network of the base of the skull, not a trabeculated venous channel. This venous pathway, the internal carotid artery, and the oculomotor cranial nerves cross the medial portion of the middle cranial fossa in an extradural space formed on each side of the sella turcica by the diverging aspects of a dural fold. In this space the venous pathway has only neighborhood relations with the internal carotid artery and the cranial nerves. The space itself must be distinguished from the vascular and nervous elements that it contains. The revision of the anatomy of this region has not only theoretical interest but also important clinical implications.

Glial Heterotopia of Sphenoid in Association with a Patent Sternberg's Canal presenting with Meningitis

2015 ◽  
Vol 7 (1) ◽  
pp. 23-25
Author(s):  
R Suma ◽  
KJ Jeena ◽  
VM Pavithran ◽  
A Govindan
Keyword(s):  
Sphenoid Sinus ◽  
Radiological Finding ◽  
Lateral Wall ◽  
Middle Cranial Fossa ◽  
Developmental Anomaly ◽  
Csf Rhinorrhea ◽  
Cranial Fossa ◽  
Extended Endoscopic Approach ◽  
Glial Heterotopia ◽  
Csf Leaks

ABSTRACT Ectopic glial tissue, presenting at various sites of body is a rare embryonic developmental anomaly. Very few cases are reported in adults, most being incidentally detected, revealed only by histopathological findings. One of the rarest locations is the sphenoid sinus. We present here the case of a middle aged female, presenting with spontaneous cerebrospinal fluid (CSF) rhinorrhea and meningitis. With the radiological finding of a soft tissue density in sphenoid sinus with erosion of left temporal skull base, she underwent lateral craniotomy, with excision of the mass and middle cranial fossa floor repair. Histopathology revealed a heterotopic glial tissue. Peroperative finding of a well-defined defect in the lateral wall of an extensively pneumatized sphenoid showed typical features of a patent Sternberg's canal. This case could be a living proof for the existence of this rare developmental anomaly. A persisting Sternberg's canal should be considered as the source of spontaneous CSF leaks with or without lesions in sphenoid sinuses with extensive lateral pneumatization. Most of the cases may be treated with an extended endoscopic approach. Extreme lateral lesions like this would benefit most from a craniotomy approach for proper closure of skullbase defect. Three years after successful surgery, she remains symptom free.

scholarly journals Spontaneous Temporal Lobe Encephalocele Within the Sphenoid Sinus

2021 ◽  
Vol 18 (1) ◽  
pp. 63-66
Author(s):  
Mohammed Dhaha ◽  
Abdelhafidh Sliman ◽  
Nadhir Karmeni ◽  
Sawsen Dhambri ◽  
Jalel Kallel
Keyword(s):  
Sphenoid Sinus ◽  
Lateral Wall ◽  
Middle Cranial Fossa ◽  
Clinical Aspect ◽  
Csf Leak ◽  
Surgical Approaches ◽  
Skull Defect ◽  
Lethal Complications ◽  
Transcranial Approach ◽  
Cranial Fossa

Encephaloceles are herniation of cranial content arising from a skull defect. Encephaloceles of the lateral wall of the sphenoid sinus (ELWSS) are  uncommon events. In most cases, these cranial hernias are secondary to trauma and craniofacial surgery. Spontaneous forms are evenrarer and not well understood. The most adopted hypothesis is a persisting Sternberg’s canal, an embryonic remnant connecting the middle cranial fossa and the nasopharynx. ELWSS are usually revealed by cerebrospinal fluid (CSF) leak. Diagnosis of this disease necessitates quick management due to the potential of lethal complications such as meningitis. We report the case of a spontaneous ELWSS in a 53-year-old woman revealed by CSF leak which was successfully managed with a conventional transcranial approach. We focus on the clinical aspect and pathogenesis of the disease, and discuss the main possible surgical approaches. Keywords: Spontaneous encephalocele, Sphenoid sinus, CSF leak, Transcranial approach

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