By Vinko V. Dolenc M.D., Ph.D. (auth.)
The determination of Harvey Cushing to depart basic surgical procedure and focus on the newborn box of critical apprehensive procedure surgical procedure used to be looking back a landmark within the heritage of neurosurgery. His focused paintings, and in addition that of his colleague Walter Dandy, originated with the wishes of either pioneers to appreciate surgical anatomy and neurophysiology. the basic wisdom and surgical techni ques that they supplied grew to become the traditional of excellence for a number of generations of neurosurgeons; lots in order that the final trust used to be that the surgical thoughts couldn't be superior upon. Twenty-five to thirty years in the past microtechniques started to appear in a couple of surgical examine facilities, they have been then steadily utilized to medical neurosurgery and feature contributed to a brand new point of figuring out in surgical anatomy and neurophysiology. we're now lucky to have a brand new ordinary of morbidity and mortality within the surgery of intrathecal aneurysms, angiomas, and tumors. it's been acknowledged that microneurosurgery was once attaining its limits, specially while treating lesions in and round the cavernous sinus and cranium base; these lesions infamous for involvement of the dural and extradural cubicles, with a bent to infiltrate adjoining nerves and blood vessels. the risks of uncontrollable hemorrhage from the basal sinuses and post-operative CSF rhinorrhea seemed unsurmountable. The lateral facets of the petro-clival area were of curiosity to a couple pioneering ENT surgeons and neurosurgeons however the cavernous sinus in such a lot respects has remained the ultimate unconquered summit.
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Additional info for Anatomy and Surgery of the Cavernous Sinus
Lateral to the sphenopetrous fissure and to the greater petrosal nerve is the posterolateral triangle. On the medial side of the sphenopetrous fissure and greater petrosal nerve is the posteromedial triangle the labyrinthine branch of the middle meningeal artery coursing parallel to the greater superficial petrosal nerve, the greater and lesser superficial petrQsal nerves and the tensor tympani muscle and the Eustachian tube separated from the leA by a 1-2 mm thick bone wall. It should be noted that within this region the structures coursing nearly along the parasagittal plane maintain a parallel relationship to each other.
The entire medial loop of the ICA is visualized from both the medial and lateral sides . On the medial side of Parkinson's triangle the paramedial triangle is wide open. The VIth nerve on the lateral side is covered by the GG and VI 35 Parasellar subregion III IV MHl ILl ICA(ML) 36 The surgical triangles of the cavernous sinus Fig. 15. In the anterior area of the anterolateral triangle a huge vein enters the lateral wall of the CS. The intense blue color of the lateral wall of the CS indicates that there is abundant blood between its layers Middle cranial fossa subregion 37 Middle cranial fossa subregion CV ACP IV Anterolateral triangle The lateral edge of VI (medial border), the medial edge of V2 (lateral border), and the anterolateral wall of the bony middle cranial fossa (anterior border).
Its most important feature is that the IVth nerve and VI run over the IIIrd nerve before they enter the SOF. Deep in the center of this corner, the VIth nerve is seen embedded in "venous blood" Oculomotor trigone The triangular area of the oculomotor trigone, described previously , is located between the folds of the dura running between the ACP and the PCP, and medially with the fold of the dura running from the PCP to the ACP. This triangle is situated posterior to the base of the paramedial and anteromedial triangles, and anterolateral to the inferomedial triangle.