Microsurgical anatomy and clinical application of transcranial operation on cavernous sinus

Objective:To study the microstructure of cavernous sinus exposed by different surgical approaches through frontotemporal orbitozygomatic craniotomy and to provide safe operative approaches for direct operation on cavernous sinus.Methods: The microstructure of the cavernous sinus of 10 adult cadaveric heads were observed under microscope through lateral extradural approach,lateral intradural approach and superior approach.The clinical data of 16 cavernous sinus lesions were analyzed.Results: Lateral extradural approach could be used to expose the second and third branches of trigeminal nerve,trigeminal ganglion,posterior vertical segment of the intrapetrosal ICA,abducent nerve and horizontal segment of the intrapetrosal ICA;lateral intradural approach could be used to expose the lateral,anteroinferior and posterosuperior venous spaces,almost all the cranial nerves within the cavernous sinus and horizontal segments of the intracavernous ICA;superior approach could be used to expose the medial,lateral and posterosuperior venous spaces,medial side of the anterior genu,anterior vertical and clinoidal segments of the intracavernous ICA and the lateral side of the hypophysis.Conclusion:According to the location of the cavernous sinus lesions,different surgical approaches to the cavernous sinus in the frontotemporal orbitozygomatic craniotomy could be used to safely expose the lesion without imparing important nerves and vessels.