Humans ; Cavernous Sinus/surgery* ; Endoscopy ; Neoplasms

This paper describes an extradural approach to the lateral sellar compartment (LSC, cavernous sinus), which represents a refinement of the original work performed on this topic by Parkinson, Dolenc, and Hakuba, and other enthusiastic neurosurgeons. This detailed description of the extradural approach is based on the dissection of 30 cadaver specimens and surgical experience of 110 LSC lesions. The extradural approach is based on the developmental anatomy of the LSC, and provides: (1) complete exposure of the entire LSC; (2) excellent control of the intracavernous carotid artery; (3) easier identification and less injury of the cranial nerves; (4) reduced brain damage with limited extradural retraction; (5) preserving the Sylvian vein and the sphenoparietal sinus; (6) minimal intradural blood spillage; (7) shorter operative time; (8) physiological reconstruction of the lateral wall to prevent CSF leakage; and (9) access to the contralateral LSC. As the LSC is an extradural space, the extradural approach may be safely employed to access lesions involving the LSC.
Cavernous Sinus/surgery* ; Cavernous Sinus/anatomy & histology ; Craniotomy ; Dissection ; Human ; Microsurgery

OBJECTIVEThe anatomic features of transsphenoidal approach are reviewed, focusing on the microsurgical anatomy of suprasellar and parasellar structures. Pertinent microsurgical anatomy is described for neurosurgeons to successfully extend a standard transsphenoidal approach for treatment of lesions including the region of the tuberculum sellae, planum sphenoidale, supradiaphragmatic intradural space, and medial cavernous sinus.

METHODS15 specimens (30 sides) from formalin fixed cadaveric heads and 20 adult dry skulls (40 sides) were observed. According to the need for the extend transsphenoidal approach, the sellar and parasellar region: the planum sphenoidale and the supradiaphragmatic area, medial part of cavernous sinus were studied. Special emphases were put on the relation of the cranial nerve and blood vessel structures surrounding the sellar. Meanwhile, we made the cast specimen of the blood vessel and studied the structure character of the internal carotid artery in the cavernous sinus.

RESULTSPosterior ethmoidal could be exit as para or suprasphenoidal ethmoidal air cell. It will be important for extending the transsphenoidal approach. The mean distance between two optic canal is 15.7 +/- 3.2 mm (11.0 - 18.0 mm), the distance of internal carotid artery at tuberculum cellae level is 13.9 +/- 3.8 mm (10.0 - 17.0 mm), the mean distance between tuberculum cellae and the posterior rim of cribriform plate is 23.3 +/- 3.2 mm, the included angle between sagittal plane and optic canal is 36.3 degrees +/- 1.6 degrees , with the anatomy research data give the clue that the bone window should be made as the shape of "[see text]".

CONCLUSIONSExpending transsphenoidal approach is suitable for medium and small lesions growing along the centre line which expand to para sellar, anterior sellar and sphenoid platform. That hypophysis has close relation with internal carotid artery during expending transsphenoidal approach to cavernous sinus increase the risk of operation. The carotid artery and abducent nerve are the easiest structures to be damaged during the operation.

Adult ; Cadaver ; Cavernous Sinus ; anatomy & histology ; surgery ; Humans ; Sphenoid Bone ; anatomy & histology ; surgery ; Sphenoid Sinus ; anatomy & histology ; surgery

OBJECTIVETo study the anatomical and morphological characteristics of the venous spaces involved in surgery via transsphenoidal approach to the cavernous sinus (CS).

METHODSTen fixed cadaver heads (six male, four female) with red and blue latex injected in the arteries and veins, respectively, were used to perform the transsphenoidal approach. The anterior wall of the sphenoidal sinus and the floor of sellar turcica were opened as much as possible to expose the dura mater at the sellar floor and the inferior wall of CS, and the location of the anterior and inferior intercavernous sinuses were observed carefully. All the spaces of CS were observed and measured. According to the observations, the venous spaces available for operation were identified and analyzed.

RESULTSIn all the cadaver heads, 4 anterior and 5 inferior intercavernous sinuses were found, with the former locating below the optic protuberance, while the latter situated at the turn of the sellar protuberance at the clival indentation. CS was subdivided into medial space, inferolateral space, and dorsolateral space.

CONCLUSIONSIn transsphenoidal approach, opening of anterior and inferior intercavernous sinus is liable to result in intra- and postoperative venous bleeding, and understanding of the location of the intercavernous sinus and appropriate utilization of these CS may help reduce intraoperative vascular and nerve injury.

Cadaver ; Cavernous Sinus ; anatomy & histology ; surgery ; Female ; Humans ; Male ; Models, Anatomic ; Neurosurgical Procedures ; Sphenoid Sinus ; anatomy & histology ; blood supply ; surgery

In the Department of Oral and Maxillofacial Surgery, patients with trismus can be easily identified. If the cause of trismus is infection of the masticatory space near the pterygoid plexus, the possibility of cavernous sinus thrombosis should be considered. We report the case of a patient who presented with limited mouth opening and progressed to cavernous sinus thrombosis, along with a review of the relevant literature.
Cavernous Sinus Thrombosis* ; Focal Infection, Dental ; Humans ; Mouth ; Surgery, Oral ; Trismus*

An extracranial carotid artery pseudoaneurysm is a rare condition that is caused by various types of arteritis, trauma and infectious causes. Generally, a pseudoaneurysm may be difficult to treat surgically when dissecting the paraaeurysmal fibrotic dense inflammatory tissues. The surgical management of a peudoaneurysm of the carotid artery involves a risk of nerve and arterial injury. This paper reports the repair of a carotid artery pseudoaneurysm after the proximal and distal control of the internal carotid artery using a Pruitt-Inahara shunt (P-I shunt) and the distal control of the external carotid artery using a small sized occlusion balloon catheter.
Adult ; Carotid-Cavernous Sinus Fistula/*surgery ; Human ; Male ; Vascular Surgical Procedures

Epidermoid tumor of the cavernous sinus is rare. The aim of this case report is to discuss the role of neuroendoscopes in the removal of such lesions. A 21-year-old man presented with 6-year history of progressive headache, diplopia, and visual disturbance. Work-up revealed an epidermoid tumor located in the right cavernous sinus. An extradural transcavernous approach was utilized via a traditional frontotemporal craniotomy with endoscopic assistance. The postoperative course was uneventful with immediate improvement of the patient's headache. Postoperative magnetic resonance imaging demonstrated complete removal of the tumor. There were no signs of recurrence during a 2-year follow-up period. The endoscope is a useful tool for removing epidermoid tumors from the cavernous sinus and enhances visualization of areas that would otherwise be difficult to visualize with microscopes alone. Endoscopes also help minimize the retraction of neurovascular structures.
Adult ; Cavernous Sinus/*pathology/*surgery ; Endoscopy/*methods ; Epidermal Cyst/*pathology/*surgery ; Humans ; Male ; Microsurgery/*methods ; Young Adult

Adult ; Basilar Artery ; abnormalities ; Carotid Artery, Internal ; abnormalities ; Carotid-Cavernous Sinus Fistula ; surgery ; Embolization, Therapeutic ; Humans ; Male

OBJECTIVETo evaluate the management and outcomes in patients with giant symptomatic cavernous sinus aneurysms who underwent aneurysms trapping with bypass, proximal carotid occlusion and aneurysms trapping.

METHODSTwenty-three patients with giant symptomatic cavernous sinus aneurysms underwent surgery between February 2007 and March 2013, 3 cases were male and 20 cases were female patients, the age of the patients ranged between 24 and 68 years, mean age was 54.7 years. The pre-operative digital subtraction angiography (DSA) and ballon occlusion test (BOT) were performed to confirm the diagnosis and identify hemodynamic reserve with carotid occlusion, and the aneurysms trapping with bypass, aneurysms trapping and proximal occlusion of the internal carotid artery were performed according to BOT results. During the surgery, the neurophysiological monitoring and the intraoperative CT perfusion were used. The follow-up by DSA or CT angiography were made.

RESULTSSeventeen patients underwent aneurysms trapping with bypass, 1 underwent aneurysms trapping and 5 underwent proximal occlusion of the internal carotid artery. After surgery, symptom improved in 4 cases, did not change in 10 cases, and new neural function deficit developed in 9 cases. The follow-up period were 3 months to 75 months. Two patients were lost. The Glasgow Outcome Scale of last follow-up were 5 in 19 patients, 3 in 1 patient and 1 in 1 patient.

CONCLUSIONSThe aneurysms trapping with bypass and proximal occlusion of the internal carotid artery are effective and reliable procedure for treatment of giant symptomatic cavernous sinus aneurysms in selected patients after evaluation of the pre-operative BOT, intra-operative neurophysiological monitoring and the intraoperative CT perfusion.

Adult ; Aged ; Carotid Artery Diseases ; surgery ; Carotid Artery, Internal ; surgery ; Cavernous Sinus ; surgery ; Female ; Humans ; Intracranial Aneurysm ; surgery ; Male ; Middle Aged ; Treatment Outcome

Teratomas represent 0.5% of all intracranial tumors. These benign tumors contain tissue representative of the three germinal layers. Most teratomas are midline tumors located predominantly in the sellar and pineal regions. The presence of a teratoma in the cavernous sinus is very rare. Congenital teratomas are also rare, especially those of a cystic nature. To our knowledge, this would be the first case report of a congenital, rapidly growing cystic teratoma within the cavernous sinus. A three-month-old boy presented with a past medical history of easy irritability and poor oral intake. A magnetic resonance image (MRI) scan of the head disclosed a large expanding cystic tumor filling the right cavernous sinus and extending into the pterygopalatine fossa through the foramen rotundum. These scans also demonstrated a small area of mixed signal intensity, the result of the different tissue types conforming to the tumor. Heterogeneous enhancement was seen after the infusion of contrast medium. However, this was a cystic tumor with a large cystic portion. Thus, a presumptive diagnosis of cystic glioma was made. With the use of a right frontotemporal approach, extradural dissection of the tumor was performed. The lesion entirely occupied the cavernous sinus, medially displacing the Gasserian ganglion and trigeminal branches (predominantly V1 and V2). The lesion was composed of different tissues, including fat, muscle and mature, brain-like tissue. The tumor was completely removed, and the pathological report confirmed the diagnosis of a mature teratoma. There was no evidence of recurrence. Despite the location of the lesion in the cavernous sinus, total removal can be achieved with the use of standard microsurgical techniques.
Cavernous Sinus/*pathology ; Humans ; Infant ; Magnetic Resonance Imaging ; Male ; Paranasal Sinus Neoplasms/*congenital/*diagnosis/surgery ; Teratoma/*congenital/*diagnosis ; Tomography, X-Ray Computed