Microsurgical Anatomy Of The Epidul Approach To Cavernous Sinus

Cavernous located on both sides of the sella and sphenoid sinus, so eachone, starting from the front of the superior orbital fissure, rear attached to thetip of the petrous temporal bone, the former narrow width, narrow width, is agroup around the internal carotid artery thickness ranging from venous plexusadjacent trabecular intravenous tube-like structures formed another tack. Notsimply cavernous venous access, which consists of trabecular structures, issurrounded by an outer dura. In1965, Parkinson landmark documentdescribes the treatment of carotid-cavernous fistula surgery directly into theroad,1985Dolenc development of epidural and subdural joint into the road,has become the standard treatment of disease into the cavernous sinus regionroad. Cavernous sinus is part of the skull base lesions often violated, the partsof the microscopic anatomy and surgical approach is one of the hot researchfield of neurosurgery.Objective：As an adult cadaver study, observe and measure the local anatomy of thecavernous sinus and its adjacent vital structures, or to pass through thecavernous sinus cavernous open surgical approach, providing some relevantanatomical data and precautions surgery to help you familiar with thecavernous sinus and anatomical relationship of adjacent structures, reduce andprevent the occurrence of postoperative complications.Methods：Using10%formalin fixed perfusion complete adult cadaver specimensmoist color silicone15cases (30sides), all specimens were dissected andexposed under laboratory microscope observation. Orbitozygomatic withfrontotemporal craniotomy approach, combined with epidural approach,revealing before bed suddenly, the middle meningeal artery (spine hole), mandibular nerve (foramen ovale), maxillary nerve (hole) and optic nerve(supraorbital bifida), rock shallow nerve, Peel off the outer wall of the cave-rnous sinus shallow, exposed oculomotor, trochlear nerve, trigeminal nervesection, nerve root and its three branches, exposed wall of the cavernous sinus,and near the outer sidewall of each anatomical triangle; open cavernous sinusobservation nerve to take shape and the relationship between the internal car-otid artery. Anatomical specimens process image data, it is important to meas-ure and record structures, using SPSS17.0software for statistical analysis inthe mean (range and measured value) style.Results:1, To the edge of the sphenoid plane as the base platform, ACP measuredthe length and width were9.30±1.17(7.10～11.30） mm,12.12±2.3(8.50～12.88） mm. By a thin layer of cortical and cancellous bone is composed ofthe group was found in the front room with gas clinoids13.3%, with butter-flies, ethmoid interlinked.2, the upper wall of the cavernous sinus has fourtriangular, namely: Dolenc Triangle, Hakuba triangle, the internal carotid art-ery and oculomotor triangle triangle. Trilateral triangle which Dolenc lengthare: medial side (9.40±2.43) mm, the outer edge (10.2±2.36) mm, bottom(7.67±2.13) mm. Hakuba trilateral triangle length: medial side (7.64±2.06)mm, the outer edge (7.18±2.10) mm, the bottom (4.21±1.36) mm.3, thereare six triangular lateral wall of the cavernous sinus and its vicinity, wereinside the triangle beside, Parkinson Triangle, Mullan triangle, outside thetriangle, Glasscock triangle and Kawase triangle. Trilateral triangle whichParkinson length were: medial side (17.26±3.07) mm, the outer edge(14.22±3.93) mm, the bottom (5.86±2.54) mm, cavernous sinus surgery isthe most commonly used gap. Glasscock triangle trilateral length: medial side(12.32±2.40) mm, the outer edge (13.85±2.64) mm, the bottom (6.85±2.16)mm. Strictly speaking, is a quadrilateral. Length Kawase trilateral triangle:inside edge (14.86±2.74) mm, the outer edge (12.82±2.30) mm, bottom(11.24±3.42) mm.4, oculomotor, trochlear nerve and optic nerve in thecavernous walk the length of the line were:(8.18±0.92) mm,(10.15±1.12) mm,(16.25±2.22) mm.Conclusion:Frontotemporal orbitozygomatic surgical approach, before it can berevealed, middle cranial fossa, orbital apex and cavernous sinus. Craniotomyprocess some specific operating practices and procedures according to thelesion, surgery and doctors need to change habits. MacCarty hole location iskey orbitozygomatic craniotomy, which is located above the foreheadCondorcet butterfly stitch1/3. Epidural mill ACP can be clearly identifiedlateral superior orbital fissure and optic canal above the bone, into the superiororbital fissure and optic canal subdural continuity is also very easy to get theanatomical position, it is beneficial for the former ACP, the superior orbitalfissure outside, above the optic canal bone mill addition and protection of thesurrounding neurovascular structures; former mill after clinoids addition totemporary occlusion of the internal carotid artery ACP gap, the ACP internalcarotid artery segment in the far and near ring ring room, open the internalcarotid artery and optic nerve sheath away ring can fully reveal the innercarotid artery, the anterior, enough to meet the clinoid segment aneurysmsrequire surgical exposure.