| Objective:The cavernous sinuses are venous structures in the middle fossa. It is very difficult to expose due to its deep location. Many diseases in this region are needed to treat by surgery. We use anatomical methods to investigate the morphological characteristics of adult specimens and to provide anatomic basis for the operation of CS.Methods:Location, surrounding structures, structures of lateral wall, superior wall, medial wall and posterior wall of CS were dissected, observed and measured on16sides from8cadaveric heads. Especially, focused on the following contents:Dural structure, anatomic triangles and nerves of the wall of CS. Location and surrounding structures of ACP.Location,course of the intracavernous internal carotid artery.Location, course and surrounding structure of nerve through CS.Results:①Average distances from the anterior nasal spina to the ostia of sphenoidal sinus, sphenopalatine foramen,and anterior clinoid process were (58.53±5.11) mm,(50.33±2.42) mm,(80.02±4.96) mm.The Angles between the attachment and sagittal alignment were acute angle, respectively (34.0and2.9) degrees,(20.0and3.5) degrees and (35.2and3.8)degrees.①Only a few specimens can found optic nerve uplift in sphenoid sinus or in ethmoid sinus (4cases and5cases respectively), most of the specimens in sphenoid sinus and ethmoid sinus is visible in the optic nerve uplift (7cases). Most of the specimens in sphenoid sinus can be seen in the internal carotid artery uplift (11cases).③By endonasal transsphnoid approaches to cavernous sinus,we can grind part bone of the inside wall of CS to expose internal carotid artery,the part in the cavernous sinus and observe cranial nerves in the sinus.④The external wall of the cavernous sinus was tough and composed by internal cerebral dura mater and cranial nerve sheath membrane layer,which was easy tear.Cranial nerves were attached to the inner membrane layer(cranial nerve sheath membrane layer). The inside wall of cavernous sinus were thinner at both ends and differ, front upper part was like fiber membrane, and1case did not be saw in specimen, the lower was a tough, dural samples.⑤Ihe cavernous sinus was filled with venous blood,which was complex for venous blood vessels plexus and networks, it can be divide into five gaps:former gap, the medial clearance, the lateral clearance, before the clearance and the clearance under after five clearance, but can be absent;⑥Triangles of cavernous sinus:Parkinson’s triangle:Trochlear nerve (15.33±4.21) mm; Ophthalmic nerve (16.96±4.53) mm; Tentorial edge (6.96±2.60) mm. Mullan’s triangle:Ophthalmic nerve (16.47±2.36) mm; Maxillary nerve (12.58±2.17) mm; Line between foramen rotundum and superior orbital fissure (8.78±2.95) mm). Lateral triangle:superior maxillary nerve (12.97±2.35)mm; inferior maxillary nerve (6.65±1.56); line between the foramen rotundum and the foramen ovale (8.78±2.95) mm.⑦Anteromedial (Dolenc) triangle:medial edge is optic nerve,(9.38±2.51) mm: lateral edge is oculomotor nerve,(10.2±2.36)mm; edge of bottom, (7.68±2.13)mm. Medial (Hakuba) triangle:medial edge is line between lateral ring of ICA and margin of the posterior clinoid process,(7.76±1.99) mm; the length of lateral edge,(7.02±1.55) mm; the length of edge of bottom,(4.31±1.48) mm.Conclusions:The cavernous sinus is located deeply in the cranial nest, adjacent to the blood vessels and nerves,which is one of the most difficult neurosurgical areas. Familiar with the anatomy structure of sphenoid sinus and cavernous sinus,we can avoid injurying blood vessels and important nerve in operation, effectively deal with intraoperative accidents and improve the effectiveness and safety of operation. The endoscopic endonasal transsphnoid approaches tc cavernous sinus can take better expose vision than routine microscope, reduce blind area, make surgery safer, concise and effective. |
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