Yasuda Alexandre, Campero Alvaro, Martins Carolina, Rhoton Albert L, de Oliveira Evandro, Ribas Guilherme C
Department of Neurological Surgery, University of Florida, Gainesville, Florida 32610-0265, USA.
Neurosurgery. 2008 Jun;62(6 Suppl 3):1240-63. doi: 10.1227/01.neu.0000333790.90972.59.
The aim of this article is to describe the anatomy of the cavernous sinus and to provide a guide for use when performing surgery in this complex area. Clinical cases are used to illustrate routes to the cavernous sinus and its contents and to demonstrate how the cavernous sinus can be used as a pathway for exposure of deeper structures.
Thirty cadaveric cavernous sinuses were examined using x3 to x40 magnification after the arteries and veins were injected with colored silicone. Distances between the entrance of the oculomotor and trochlear nerves and the posterior clinoid process were recorded. Stepwise dissections of the cavernous sinuses, performed to demonstrate the intradural and extradural routes, are accompanied by intraoperative photographs of those approaches.
The anatomy of the cavernous sinus is complex because of the high density of critically important neural and vascular structures. Selective cases demonstrate how a detailed knowledge of cavernous sinus anatomy can provide for safer surgery with low morbidity.
A precise understanding of the bony relationships and neurovascular contents of the cavernous sinus, together with the use of cranial base and microsurgical techniques, has allowed neurosurgeons to approach the cavernous sinus with reduced morbidity and mortality, changing the natural history of selected lesions in this region. Complete resection of cavernous sinus meningiomas has proven to be difficult and, in many cases, impossible without causing significant morbidity. However, surgical reduction of such lesions enhances the chances for success of subsequent therapy.
本文旨在描述海绵窦的解剖结构，并为在这一复杂区域进行手术提供操作指南。通过临床病例来说明进入海绵窦及其内容物的路径，并展示如何将海绵窦用作暴露更深层结构的通道。
在向动脉和静脉注射彩色硅胶后，使用3倍至40倍放大倍数对30个尸体海绵窦进行检查。记录动眼神经和滑车神经入口与后床突之间的距离。对海绵窦进行逐步解剖以展示硬膜内和硬膜外路径，并伴有这些入路的术中照片。
由于存在高密度的极其重要的神经和血管结构，海绵窦的解剖结构很复杂。一些特定病例表明，对海绵窦解剖结构的详细了解有助于实现更安全的手术，降低发病率。
精确了解海绵窦的骨性关系和神经血管内容，同时运用颅底和显微外科技术，使神经外科医生能够以降低发病率和死亡率的方式接近海绵窦，改变了该区域某些病变的自然病程。事实证明，完全切除海绵窦脑膜瘤很困难，而且在许多情况下，如果不造成明显的发病率，根本无法做到。然而，手术切除此类病变会增加后续治疗成功的机会。
