By Vinko V. Dolenc M.D., Ph.D. (auth.)
The selection of Harvey Cushing to depart basic surgical procedure and focus on the child box of vital frightened process surgical procedure used to be looking back a landmark within the background of neurosurgery. His focused paintings, and in addition 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; quite a bit in order that the final trust used to be that the surgical recommendations couldn't be more desirable upon. Twenty-five to thirty years in the past microtechniques started to appear in a couple of surgical study facilities, they have been then steadily utilized to scientific 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 surgery of intrathecal aneurysms, angiomas, and tumors. it's been acknowledged that microneurosurgery was once achieving its limits, particularly whilst treating lesions in and round the cavernous sinus and cranium base; these lesions infamous for involvement of the dural and extradural booths, with a bent 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 elements of the petro-clival sector were of curiosity to a couple pioneering ENT surgeons and neurosurgeons however the cavernous sinus in so much respects has remained the ultimate unconquered summit.
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Additional resources for Anatomy and Surgery of the Cavernous Sinus
By laterally drilling the bone of the middle fossa additional space is gained for a better lateral approach. The lateral triangle of the left CS is shown in Figs. 21-25. 50 The surgical triangles of the cavernous sinus Fig. 22. The lateral triangle is much smaller than the anterolateral triangle. It is completely filled with "venous blood". Through the transparent blue venous injection, the arterial branch is visible. Note that V3 is much shorter than V2 and that the GG is much closer to the foramen ovale than to the foramen rotundum Sl Middle cranial fossa subregion FO PR MM DR OA FR IV III leA 52 The surgical triangles of the cavernous sinus Fig.
Note that V3 is much shorter than V2 and that the GG is much closer to the foramen ovale than to the foramen rotundum Sl Middle cranial fossa subregion FO PR MM DR OA FR IV III leA 52 The surgical triangles of the cavernous sinus Fig. 23. The lateral triangle is shown under higher magnification. The only possibility of enlarging this triangle is by drilling the bone in a lateral direction. In order to gain better access to the space below the GG, the bone is ground laterally. Through the grey blue transparent venous injection the arterial branch is seen 53 Middle cranial fossa subregion FO GG 54 The surgical triangles of the cavernous sinus Fig.
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.