IJAR.2023.160
Type of Article: Review
Volume 11; Issue 3 (September 2023)
Page No.: 8677-8684
DOI: https://dx.doi.org/10.16965/ijar.2023.160
Microsurgical Anatomy of the Cavernous Sinus: A Neurosurgical Perspective
Juan Armando Mejía 1, Maximiliano Paez Nova 2, Luis Garcia Rairan *1
*1 MD Department of Neurosurgery. Fundación Santa Fe. Bogotá Colombia.
2 MD Department of Neurosurgery. High Complexity Clinic of the Caribbean, Valledupar, Cesar, Colombia.
Corresponding Author: Luis Garcia Rairan. Fundación Santa Fe 116-, Ak. 9, Bogotá, Colombia. Postal Code: 110111 E-Mail: Lagarciar@unbosque.edu.co
ABSTRACT
Background: The cavernous sinus (CS) is a complex anatomical structure that poses significant challenges to neurosurgeons performing surgical interventions in this region. A comprehensive understanding of the anatomy of the CS, including its relevant landmarks and structures, is crucial for successful surgical outcomes.
Objective: This review aimed to provide a comprehensive overview of the anatomy of the CS, including relevant anatomical landmarks and structures, as well as surgical approaches for neurosurgeons.
Methods: A literature search was conducted in electronic databases, including PubMed, Embase, and Scopus, using the keywords “cavernous sinus,” “neuroanatomy,” and “neurosurgery.” Inclusion criteria included all articles published in the English language. Two independent reviewers screened the titles and abstracts, and relevant data was extracted from the included articles and synthesized for narrative synthesis.
Results: A thorough comprehension of the eleven triangles in the parasellar region, medial fossa, and paraclival region is imperative for neurosurgeons to navigate complex anatomical structures during surgical approaches to the CS. These structures’ anatomical relationships and spatial organization were summarized, along with an overview of relevant surgical approaches.
Conclusion: The anatomy of the CS is complex and requires a thorough comprehension of the relevant anatomical landmarks and structures and surgical approaches. Neurosurgeons must comprehensively understand the eleven triangles in the parasellar region, medial fossa, and paraclival region to navigate the complex anatomical structures during surgical interventions effectively. This knowledge can enhance surgical precision and reduce the risk of complications, ultimately improving patient outcomes.
Key Words: Microsurgical Anatomy, Cavernous Sinus, Neurosurgical, Surgical Interventions.
REFERENCES
[1]. B. López Álvarez. Anatomia endoscópica del seno cavernoso con finalidad quirúrgica. Jun. 2014. doi: 10.14201/GREDOS.125444.
[2]. T. Fukushima. Management of Cavernous Sinus Lesions. Practical Handbook of Neurosurgery 2009;pp. 629–654. doi: 10.1007/978-3-211-84820-3_39.
[3]. D. Parkinson. A Surgical Approach to the Cavernous Portion of the Carotid Artery: Anatomical Studies and Case Report. J Neurosurg 1965;23(5):474–483. doi: 10.3171/JNS.1965.23.5.0474.
[4]. A. A. Bakan et al., Cavernous Sinus: A Comprehensive Review of its Anatomy, Pathologic Conditions, and Imaging Features. Clin Neuroradiol 2015;25(2):109–125. doi: 10.1007/S00062-014-0360-0/TABLES/1.
[5]. H. Q. Truong, S. Lieber, E. Najera, J. T. Alves-Belo, P. A. Gardner, and J. C. Fernandez-Miranda. 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.
[6]. J. C. Fernandez-Miranda et al., 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.
[7]. J. Diaz Day, T. Fukushima, and S. L. Giannotta. Cranial base approaches to posterior circulation aneurysms. J Neurosurg, 1997;87(4):544–554. doi: 10.3171/JNS.1997.87.4.0544.
[8]. A. M. Korchi, V. Cuvinciuc, J. Caetano, M. Becker, K. O. Lovblad, and M. I. Vargas. Imaging of the cavernous sinus lesions,” Diagn Interv Imaging. 2014;95(9):849–859. doi: 10.1016/J.DIII.2013.04.013.
[9]. Z. H. Qian, X. Feng, Y. Li, and K. Tang. Virtual Reality Model of the Three-Dimensional Anatomy of the Cavernous Sinus Based on a Cadaveric Image and Dissection. Journal of Craniofacial Surgery. 2018;29(1):163–166. doi: 10.1097/SCS.0000000000004046.
[10]. G. R. Isolan, N. Krayenbühl, E. de Oliveira, and O. Al-Mefty. Microsurgical anatomy of the cavernous sinus: Measurements of the triangles in and around it. Skull Base 2007;17(6):357–368. doi: 10.1055/S-2007-985194/ID/40.
[11]. B. S. Chung, Y. H. Ahn, and J. S. Park. Ten Triangles around Cavernous Sinus for Surgical Approach, Described by Schematic Diagram and Three Dimensional Models with the Sectioned Images. J Korean Med Sci. 2016; 31(9):1455–1463. doi: 10.3346/JKMS.2016.31.9.1455.
[12]. V. R. Chavez-Herrera et al. Microsurgical and illustrative anatomy of the cavernous sinus, middle fossa, and paraclival triangles: a straightforward, comprehensive review. Surgical and Radiologic Anatomy 2023;1(1–12). doi: 10.1007/S00276-023-03105-Y/FIGURES/12.
[13]. R. V. Alves, L. C. Sousa, J. P. A. Rodrigues, and K. A. C. Laube. Revisiting Parkinson: After six decades, his triangle remains useful,” Surg Neurol Int 2022;13(483). doi: 10.25259/SNI_764_2022.
[14]. P. Zhang, H. Xi, and W. Li, “The Clinical Anatomy of the Cavernous Sinus. Forensic Med Anat Res 2015;03(02):66–75. doi: 10.4236/FMAR.2015.32012.
[15]. V. Volovici and R. Dammers. How I do it: proximal control in parkinson’s triangle for a very large paraclinoid aneurysm. Acta Neurochir (Wien) 2021;163(11):2967–2971. doi: 10.1007/S00701-021-04961-6/FIGURES/4.
[16]. H. Kına, A. Ayran, and İ. Demirtaş. Microsurgical anatomy of the cavernous sinus and limitations of surgical approaches: a cadaveric study. Folia Morphol (Warsz), Dec. 2022, doi: 10.5603/FM.A2022.0106.
[17]. F. Chowdhury et al., Transcranial microsurgical and endoscopic endonasal cavernous sinus (CS) anatomy: A cadaveric study. J Neurol Surg A Cent Eur Neurosurg 2012;73(5):296–306, Sep. 2012, doi: 10.1055/S-0032-1322519/ID/JR110495OA-37.
[18]. D. Drazin et al., Intracranial Anatomical Triangles: A Comprehensive Illustrated Review. Cureus, 2017;9(10). doi: 10.7759/CUREUS.1741.
[19]. A. Demerdash and R. Shane Tubbs. The Cavernous Sinus, Anatomy, Imaging and Surgery of the Intracranial Dural Venous Sinuses 2020;pp. 135–148. doi: 10.1016/B978-0-323-65377-0.00015-5.
[20]. A. U. Siddiqui, R. Gurudiwan, A. T. Siddiqui, N. Chaudhary, M. R. John, and P. Gupta. Morphometry of glasscock’s triangle pertinent to the exposure of horizontal intrapetrosal segment of the internal carotid artery,” National Journal of Clinical Anatomy. 2019;8(3):93. doi: 10.1055/S-0039-1697882.
[21]. M. Labib, A. Samy Y. The Cavernous Sinus: Surgical Approaches—Endoscopic and Open. Contemporary Skull Base Surgery, 2022;pp. 331–346. doi: 10.1007/978-3-030-99321-4_22.
[22]. M. Tripathi et al., Quantitative analysis of the Kawase versus the modified Dolenc-Kawase approach for middle cranial fossa lesions with variable anteroposterior extension. J Neurosurg, 2015;123(1):14–22. doi: 10.3171/2015.2.JNS132876.
[23]. H. Borghei-Razavi et al.. Anterior petrosal approach: The safety of Kawase triangle as an anatomical landmark for anterior petrosectomy in petroclival meningiomas. Clin Neurol Neurosurg 2015;139:282–287. doi: 10.1016/J.CLINEURO.2015.10.032.
[24]. G. Wysiadecki et al. Microsurgical Anatomy of the Inferomedial Paraclival Triangle: Contents, Topographical Relationships and Anatomical Variations. Brain Sciences 2021;11(5):596. doi: 10.3390/BRAINSCI11050596.
[25]. V. R. Chavez-Herrera et al. Microsurgical and illustrative anatomy of the cavernous sinus, middle fossa, and paraclival triangles: a straightforward, comprehensive review. Surgical and Radiologic Anatomy 2023;1:1–12. doi: 10.1007/S00276-023-03105-Y/FIGURES/12.