By Vinko V. Dolenc M.D., Ph.D. (auth.)
The determination of Harvey Cushing to depart common surgical procedure and focus on the baby box of crucial frightened approach surgical procedure used to be on reflection a landmark within the historical past of neurosurgery. His focused paintings, and likewise that of his colleague Walter Dandy, originated with the wishes of either pioneers to appreciate surgical anatomy and neurophysiology. the elemental wisdom and surgical techni ques that they supplied grew to become the traditional of excellence for numerous generations of neurosurgeons; loads in order that the final trust was once that the surgical options couldn't be more desirable upon. Twenty-five to thirty years in the past microtechniques started to appear in a couple of surgical examine facilities, they have been then steadily utilized to medical neurosurgery and feature contributed to a brand new point of realizing in surgical anatomy and neurophysiology. we're now lucky to have a brand new average of morbidity and mortality within the surgical procedure of intrathecal aneurysms, angiomas, and tumors. it's been acknowledged that microneurosurgery used to be attaining its limits, in particular whilst treating lesions in and round the cavernous sinus and cranium base; these lesions infamous for involvement of the dural and extradural booths, with an inclination to infiltrate adjoining nerves and blood vessels. the risks of uncontrollable hemorrhage from the basal sinuses and post-operative CSF rhinorrhea seemed unsurmountable. The lateral features of the petro-clival zone were of curiosity to some pioneering ENT surgeons and neurosurgeons however the cavernous sinus in so much respects has remained the ultimate unconquered summit.
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Extra resources for Anatomy and Surgery of the Cavernous Sinus
19. The entire anterolateral triangle is shown from its apex at the GG to its base at the bone of the middle fossa between the SOF and the foramen rotundum. At the front part of the anterolateral triangle "venous blood" is seen covering the fatty tissue usually found in this region. Slight retraction of VI toward the medial side exposes the Vlth nerve. The "venous pool" in the sinus as well as the arterial branches supplying the nerves are shown ubregion nial fossa S M id d le cra FR FT VI PR OA DR GG VJ IV 45 III leA.
The inner layer of the lateral wall in the area of the anterolateral triangle lying over VI and V2 is visualized after removal of the "venous pool". At the most anterior point of the anterolateral triangle the inflow of "venous blood" from the vein into the CS is seen. Due to the engorged vein, in the lateral wall of the CS, VI is displaced medially Middle cranial fossa subregion 41 ACP leA 42 The surgical triangles of the cavernous sinus Fig. 18. The inner layer of the lateral wall of the CS lying over Vl and V2 has been removed .
24. After removal of "venous blood" and slight retraction of the GG, the lateral loop of the ICA can be reached. Thus, the lateral triangle is very important for it gives a safe access to the lateral loop of the ICA Middle cranial fossa subr egio n leA FO 55 leA (LL) FR 56 The surgical triangles of the cavernous sinus Fig. 25. The Vth nerve together with the GG is elevated thereby exposing the lateral loop. In this figure, the entire course of the ICA from the foramen lacerum to the PCP, that is, from the lateral to the medial loop, can be traced.