The microscopic cavernous sinus surgery via the extended transsphenoidal approach:an anatomical study of cavernous sinus

Objective This study aimed to establish an anatomic basis for the microscopic surgical anatomy of the cavernous sinus via the extended transsphenoidal approach.Methods Simulated surgery via extended transsphenoidal approach was performed on seven adult cadaver heads with red-colored latex injected arteries.The cavernous segment of the ICA and its branch vessels and its relationship with cranial nerve were exposed and its anatomic parameters were measured under microscope.Results The tuberculum sellae,clivus,sellar base,ICA prominence,and optic nerve prominence are the important bone landmarks to define the surgical area.The average of the extent of bone removal of extended transsphenoidal approach is 37.6 mm (range:28.7 mm～44.0 mm).Conclusions The bone removal from sellar base to the media edge of the foramen rotundum and over the ICA prominence can effectively expose the entire unilateral cavernous sinus.The microscopic cavernous sinus surgery via the extended transsphenoidal approach is an optimal surgical approach for the lesions that invade the cavernous sinus from sella.