scholarly journals Blood Supply of Cranial Nerves Passing Through the Cavernous Sinus: An Anatomical Study and Its Implications for Microsurgical and Endoscopic Cavernous Sinus Surgery

2021 ◽  
Vol 11 ◽  
Author(s):  
Edinson Najera ◽  
Bilal Ibrahim ◽  
Baha’eddin A. Muhsen ◽  
Assad Ali ◽  
Clariza Sanchez ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Blood Supply ◽  
Cavernous Sinus ◽  
Cranial Nerves ◽  
Surgical Techniques ◽  
Anatomical Study ◽  
Distal Segment ◽  
Sinus Surgery ◽  
External Carotid ◽  
Tentorial Artery

BackgroundDespite improvements in surgical techniques, cranial nerve (CN) deficits remain the most frequent cause of disability following cavernous sinus (CS) surgery. The most common tumor affecting the CS is meningioma. They originate from lateral wall and have their blood supply from meningohypophyseal trunk (MHT) and inferolateral trunk (ILT). Pituitary adenomas commonly invade the CS through its medial wall and receive blood supply form medial branches of the internal carotid artery (ICA) (superior and inferior hypophyseal arteries). Some tumors may grow within the CS (e.g. trigeminal schwannomas, hemangiomas). These tumors are fed by all the intracavernous ICA branches. Tumors involving the CS may also displace the neurovascular structures, therefore, a better understanding of intracavernous neurovascular anatomy may reduce the postoperative morbidity associated with approaching CS tumors. In this anatomical study, the anatomic variations and their clinical implications of the intracavernous CNs’ blood supply were evaluated through transcranial and endonasal routes.MethodsTwenty sides of ten adult cadaveric formalin-fixed, latex-injected specimens were dissected in stepwise fashion under microscopic and endoscopic magnification. The origin and course of the intracavernous ICA branches supplying the intracavernous CNs are studied.ResultsThe proximal segment of the oculomotor nerve receives blood supply from the ILT in 85%, and the tentorial artery of the MHT in 15% of specimens. The distal segment is exclusively supplied by the ILT. The proximal trochlear nerve receives blood supply from the ILT (75%) and the tentorial artery (25%); the distal segment is exclusively supplied by the superior orbital branch. The proximal third of the abducens nerve receives its vascularity exclusively from the dorsal meningeal artery, and its middle and distal thirds from the ILT. The ophthalmic and proximal maxillary segments of the trigeminal nerve also receive blood supply from the ILT. The distal maxillary segment is supplied by the artery of the foramen rotundum. All ILT branches terminate on the inferomedial aspects of the intra-cavernous CNs. Extensive anastomoses are found between ILT branches and the branches arising from external carotid artery.ConclusionUnderstanding the anatomy of the intracavernous ICA’s branches is important to improving surgical outcomes with tumors involving the CS.

The Blood Supply of Intracavernous Cranial Nerves: An Anatomic Study and Its Implications for Transcranial and Endoscopic Cavernous Sinus Surgery

2021 ◽  
Author(s):  
Edinson Najera ◽  
Baha'eddin Muhsen ◽  
Bilal Ibrahim ◽  
Michal Obrzut ◽  
Hamid Borghei-Razavi ◽  
...  
Keyword(s):  
Blood Supply ◽  
Cavernous Sinus ◽  
Cranial Nerves ◽  
Sinus Surgery ◽  
Anatomic Study

The Clinical Importance of the Inferolateral Trunk of the Internal Carotid Artery

Neurosurgery ◽  
1991 ◽  
Vol 28 (5) ◽  
pp. 733-738 ◽  
Author(s):  
H. Capo ◽  
M. J. Kupersmith ◽  
A. Berenstein ◽  
I. S. Choi ◽  
G. A. Diamond
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Blood Supply ◽  
Internal Carotid ◽  
Cranial Nerves ◽  
External Carotid Artery ◽  
Neurological Dysfunction ◽  
External Carotid ◽  
Gasserian Ganglion ◽  
Inferolateral Trunk

Abstract The inferolateral trunk (ILT) of the internal carotid artery (ICA) is a branch that arises inferiorly from the C4 segment of the cavernous ICA. It provides blood supply to the 3rd, 4th, and 6th cranial nerves, as well as to the gasserian ganglion. The ILT anastomoses to branches of the internal maxillary artery, providing collateral circulation between the external carotid artery and the ICA systems. Retinal and cerebral emboli can arise from the external carotid artery system and travel via the ILT to the ICA. Cranial nerve palsies may result after occlusion of the ILT. We present the cases of four patients who had iatrogenic neurological dysfunction subsequent to intravascular procedures that involved the ILT. These cases provide further clinical confirmation of the importance of this blood vessel. A 5th case involving iatrogenic occlusion of the ILT and no neurological deficit is also presented, demonstrating that the ILT is not the sole blood supply of the cranial nerves in the cavernous sinus.

Blood Supply to the Intracavernous Cranial Nerves: Comparison of the Endoscopic and Microsurgical Perspectives

2008 ◽  
Vol 62 (suppl_5) ◽  
pp. ONS305-ONS311 ◽  
Author(s):  
Elena d'Avella ◽  
Manfred Tschabitscher ◽  
Antonio Santoro ◽  
Roberto Delfini
Keyword(s):  
Blood Supply ◽  
Cavernous Sinus ◽  
Cranial Nerves ◽  
Lateral Wall ◽  
Oculomotor Nerve ◽  
Transsphenoidal Approach ◽  
Trochlear Nerve ◽  
Microsurgical Approach ◽  
Tentorial Artery ◽  
Inferolateral Trunk

Abstract Objective: To provide a comparative description of the endoscopic and microsurgical anatomic features of the blood supply to the cranial nerves in the lateral wall of the cavernous sinus. Methods: Twenty-four cavernous sinuses were dissected in 12 adult cadaveric heads. Endoscopic observations were made with 0- and 45-degree, 4-mm rod-lens endoscopes. The lateral wall of the cavernous sinus was exposed through an endonasal transsphenoidal approach. The microsurgical observations were performed with a surgical microscope with possible magnification ranging from 4× to 40× through a lateral transcranial approach. Neurovascular relationships in the lateral wall of the cavernous sinus were noted, and the endoscopic and microsurgical perspectives were compared. Results: The neurovascular relationships in the lateral wall of the cavernous sinus that are visible by the endonasal transsphenoidal approach but not visible by the transcranial microsurgical approach are as follows: between the oculomotor nerve and the tentorial artery, between the distal segment of the trochlear nerve and the tentorial artery, between the ophthalmic nerve and the inferolateral trunk, and between the abducens nerve and the inferolateral trunk. The neurovascular relationships visible by the transcranial microsurgical approach but not visible by the transsphenoidal endoscopic approach are as follows: between the oculomotor nerve and the superoproximal artery, when present, and between the proximal segment of the trochlear nerve and the superoproximal artery. Conclusion: Incorporating the endoscopic and microsurgical perspectives ensures a better understanding of the neurovascular relationships in the cavernous sinus lateral wall. This information could be relevant for preservation of the blood supply to the nerves during surgery in or around the cavernous sinus.

scholarly journals Asymptomatic Occipital Area Infarction following Carotid Body Paraganglioma Excision

2014 ◽  
Vol 5 (3) ◽  
pp. 148-151
Author(s):  
Sudhir M Naik ◽  
MK Goutham ◽  
Vishal Rao ◽  
Ravishankar S Bhat ◽  
Mohan Appaji ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Body ◽  
Cranial Nerves ◽  
Surgical Techniques ◽  
Vascular Complications ◽  
Occipital Lobe ◽  
Surgical Excision ◽  
Preoperative Imaging ◽  
External Carotid ◽  
Occipital Area

ABSTRACT Background Vascular complications are seen in 2 to 13% of cases with internal carotid artery (ICA) injuries with or without reconstruction. The hypoglossal and vagus appeared most vulnerable for permanent paralysis due to traction or resection. Mortality with surgical excision of carotid body tumor (CBT) has become negligible with newer vascular surgical techniques and the morbidity has fallen to minimal 2.56%. Case report We report a case of 24-year-old female with symptomatic CBT excision with external carotid artery (ECA) ligation. She developed asymptomatic infarction of the occipital lobe. All the cranial nerves were intact with a follow-up uneventful for the past 2 years. Conclusion Minimizing complications in CBT surgery include an accurate preoperative imaging assessment of the tumor with comorbidities and evidence-based management. How to cite this article Rao V, Naik SM, Goutham MK, Appaji M, Bhat S, Hiremat R, Rangnath N, Bhat RSS. Asymptomatic Occipital Area Infarction following Carotid Body Paraganglioma Excision. Int J Head Neck Surg 2014;5(3):148-151.

Zygomatic Approach to Cavernous Sinus Chordoma: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Antonio Aversa ◽  
Ossama Al-Mefty
Keyword(s):  
Carotid Artery ◽  
Cavernous Sinus ◽  
Infratemporal Fossa ◽  
Cranial Nerves ◽  
Radical Resection ◽  
High Rate ◽  
Petrous Apex ◽  
High Dose ◽  
Middle Fossa ◽  
Cavernous Carotid Artery

Abstract Chordoma is not a benign disease. It grows invasively, has a high rate of local recurrence, metastasizes, and seeds in the surgical field.1 Thus, chordoma should be treated aggressively with radical resection that includes the soft tissue mass and the involved surrounding bone that contains islands of chordoma.2–5 High-dose radiation, commonly by proton beam therapy, is administered after gross total resection for long-term control. About half of chordoma cases occupy the cavernous sinus space and resecting this extension is crucial to obtain radical resection. Fortunately, the cavernous sinus proper extension is the easier part to remove and pre-existing cranial nerves deficit has good chance of recovery. As chordomas originate and are always present extradurally (prior to invading the dura), an extradural access to chordomas is the natural way for radical resection without brain manipulation. The zygomatic approach is key to the middle fossa, cavernous sinus, petrous apex, and infratemporal fossa; it minimizes the depth of field and is highly advantageous in chordoma located mainly lateral to the cavernous carotid artery.6–12 This article demonstrates the advantages of this approach, including the mobilization of the zygomatic arch alleviating temporal lobe retraction, the peeling of the middle fossa dura for exposure of the cavernous sinus, the safe dissection of the trigeminal and oculomotor nerves, and total control of the petrous and cavernous carotid artery. Tumor extensions to the sphenoid sinus, sella, petrous apex, and clivus can be removed. The patient is a 30-yr-old who consented for surgery.

Retromandibular Fossa Approach to the High Cervical Internal Carotid Artery: An Anatomic Study

2008 ◽  
Vol 62 (suppl_5) ◽  
pp. ONS363-ONS370 ◽  
Author(s):  
Yusuf Izci ◽  
Roham Moftakhar ◽  
Mark Pyle ◽  
Mustafa K. Basşkaya
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Average Length ◽  
Cranial Nerves ◽  
External Carotid Artery ◽  
External Carotid ◽  
Digastric Muscle ◽  
High Cervical ◽  
Cervical Internal Carotid Artery

Abstract Objective: Access to the high cervical internal carotid artery (ICA) is technically challenging for the treatment of lesions in and around this region. The aims of this study were to analyze the efficacy of approaching the high cervical ICA through the retromandibular fossa and to compare preauricular and postauricular incisions. In addition, the relevant neural and vascular structures of this region are demonstrated in cadaveric dissections. Methods: The retromandibular fossa approach was performed in four arterial and venous latex-injected cadaveric heads and necks (eight sides) via preauricular and postauricular incisions. This approach included three steps: 1) sternocleidomastoid muscle dissection; 2) transparotid dissection; and 3) removal of the styloid apparatus and opening of the retromandibular fossa to expose the cervical ICA with the internal jugular vein along with Cranial Nerves X, XI, and XII. Results: The posterior belly of the digastric muscle and the styloid muscles were the main obstacles to reaching the high cervical ICA. The high cervical ICA was successfully exposed through the retromandibular fossa in all specimens. In all specimens, the cervical ICA exhibited an S-shaped curve in the retromandibular fossa. The external carotid artery was located more superficially than the ICA in all specimens. The average length of the ICA in the retromandibular fossa was 6.8 cm. Conclusion: The entire cervical ICA can be exposed via the retromandibular fossa approach without neural and vascular injury by use of meticulous dissection and good anatomic knowledge. Mandibulotomy is not necessary for adequate visualization of the high cervical ICA.

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.

Orbital Vascular And Lymphatic Systems

2012 ◽  
Author(s):  
David Jordan ◽  
Louise Mawn ◽  
Richard L. Anderson
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Ophthalmic Artery ◽  
Internal Carotid ◽  
External Carotid Artery ◽  
External Carotid ◽  
Sympathetic Nerve Fibers ◽  
Carotid Canal ◽  
Cervical Ganglion

The anatomy of the orbital vascular bed is complex, with tremendous individual variation. The main arterial supply to the orbit is from the ophthalmic artery, a branch of the internal carotid artery. The external carotid artery normally contributes only to a small extent. However, there are a number of orbital branches of the ophthalmic artery that anastomose with adjacent branches from the external carotid artery, creating important anastomotic communications between the internal and external carotid arterial systems. The venous drainage of the orbit occurs mainly via two ophthalmic veins (superior and inferior) that extend to the cavernous sinus, but there are also connections with the pterygoid plexus of veins, as well as some more anteriorly through the angular vein and the infraorbital vein to the facial vein. A working knowledge of the orbital vasculature and lymphatic systems is important during orbital, extraocular, or ocular surgery. Knowing the anatomy of the blood supply helps one avoid injury to the arteries and veins during operative procedures within the orbit or the eyelid. Inadvertent injury to the vasculature not only distorts the anatomy and disrupts a landmark but also prolongs the surgery and might compromise blood flow to an important orbital or ocular structure. Upon entering the cranium, the internal carotid artery passes through the petrous portion of the temporal bone in the carotid canal and enters the cavernous sinus and middle cranial fossa through the superior part of the forame lacerum . It proceeds forward in the cavernous sinus with the abducens nerve along its side. There it is surrounded by sympathetic nerve fibers (the carotid plexus ) derived from the superior cervical ganglion. It then makes an upward S-shaped turn to form the carotid siphon , passing just medial to the oculomotor, trochlear, and ophthalmic nerves (V1). After turning superiorly in the anterior cavernous sinus, the carotid artery perforates the dura at the medial aspect of the anterior clinoid process and turns posteriorly, inferior to the optic nerve.

scholarly journals Saphenous vein graft bypass in the treatment of giant cavernous sinus aneurysms: report of two cases

2000 ◽  
Vol 58 (1) ◽  
pp. 162-168 ◽  
Author(s):  
RICARDO RAMINA ◽  
MURILO S. MENESES ◽  
ARI A PEDROZO ◽  
WALTER O. ARRUDA ◽  
GUILHERME BORGES
Keyword(s):  
Carotid Artery ◽  
Cavernous Sinus ◽  
Saphenous Vein ◽  
Vein Graft ◽  
Saphenous Vein Graft ◽  
Brain Infarction ◽  
Superficial Temporal Artery ◽  
High Flow ◽  
Low Flow ◽  
External Carotid

Two cases of giant intracavernous aneurysms treated by high flow bypass with saphenous vein graft between the external carotid artery (ECA) and branches of the middle cerebral artery (MCA) are presented. Very often these aneurysms are unclippable because they are fusiform or have a large neck. Occlusion of the internal carotid artery (ICA) is the treatment of choice in many cases. This procedure has however a high risk of brain infarction. Revascularization of the brain by extra-intracranial anastomosis between the superficial temporal artery (STA) and branches of the MCA is frequently performed. This procedure provides however a low flow bypass and brain infarction may occur. We report two cases of giant cavernous sinus aneurysms treated by high flow bypass and endovascular balloon occlusion of the ICA. Immediate high flow revascularization of MCA branches was achieved and the patients showed no ischemic events. Follow-up of 8 and 14 months after operation shows patency of the venous graft and no neurological deficits. Angiographic control examination showed complete aneurysm occlusion in both cases.

Reconstruction of Cranial Nerves III through VI during Cavernous Sinus Surgery

2015 ◽  
pp. 477-481
Author(s):  
Giuseppe Lanzino ◽  
Laligam N. Sekhar ◽  
Chandra N. Sen ◽  
Spiros Pomonis
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerves ◽  
Sinus Surgery
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