Anatomic Study Of The Endoscopic Transnasal To The Cavernous Sinus And Selection Of Approach

Objective:The anatomic features of cavernous sinus were studied by different endoscopic endonasal approaches to the cavernous sinus.The anatomical landmarks of each stage of the anatomical approach were studied,and the differences between anatomical data and morphological characteristics were analyzed and compared,providing anatomical basis for clinical surgery.Methods:6 fresh Chinese adults with cervical head specimens,4 males and 2 females.10 Chinese dry skull specimens.After fresh specimen was perfused with red and blue latex,the brain tissue was preserved by 90%ethanol under low temperature.The use of 0 degrees,30 degrees by endoscopy,ipsilateral standard endoscopic endonasal approach,trans-pterygoid approach,contralateral standard endoscopic endonasal approach,ipsilateral standard endoscopic endonasal approach combined with contralateral approach complete surgical simulation.To measure and record the anatomical landmarks and anatomical data of each stage.Results:The sphenoid ostium,choanal,sphenopalatine foramen,vidian protuberance,carotid protuberance,optic protuberance,and maxillary prominence are very important anatomic landmarks for endoscopic endonasal approach.The sphenopalatine foramen has been located on the lateral nasal wall at the root of the bone structures of middle turbinate.The max diameter was 6.71±1.9mm,the distance between the anterior border and nasal spine was 51.34±3.2mm,The distance between the anterior border and vidian canal orifices was 3.12±2.9mm,The distance between the anterior border and the root of the bone structures of middle turbinate was 10.89±3.4mm,The distance between the anterior border and the root of the bone structures of superior turbinate was 8.91±1.9mm,The distance between the anterior border and the root of the bone structures of inferior turbinate was 13.11 ±3.1mm.The inferior border of the sphenoid ostium has been situated 18.0±2.3mm above the superior border of the choanal.The shortest distance between the parasellar ICA was 11.1 ±2.8mm and the longest distance was 13.6±3.2mm.The shape of the ICA can be varied:C type,L type,S type,inverted L type.The cavernous segment of the ICA can be divided into 5 segments and has 4 vessel branches.The ophthalmic artery were all originated from the cranial part of the superior horizontal segment.The meningohypophyseal trunk was originated from the medial of the hidden segment(6/12)and the medial of the inferior horizontal segment(6/12).The inferolateral trunk was originated from the lateral of the inferior horizontal segment(6/12),the lateral of the hidden segment(4/12),anterior vertical segment(2/12);the McConnel artery was originated from the medial of the inferior horizontal segment(4/12)and the medial of the hidden segment(2/12).Conclusions:The landmarks of route were easily recognized in all stage of the approaches.The trans-pterygoid approach and the contralateral approach can enlarge the view of the cavernous sinus.The selection of the approach can be related to the pneumatization of the sphenoidal sinus and the involing space of the cavernous sinus.