Abuzayed Bashar, Tanriover Necmettin, Gazioglu Nurperi, Ozlen Fatma, Cetin Gursel, Akar Ziya
Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
Surg Radiol Anat. 2010 Jun;32(5):499-508. doi: 10.1007/s00276-010-0651-3. Epub 2010 Apr 29.
The objectives of this study were to recognize the endoscopic anatomy of the cavernous sinus and to understand the standard, purely endoscopic endonasal approaches to this anatomic structure. This basic information will facilitate our surgical procedures and decrease the rate of surgical complications.
Seven fresh adult cadavers were studied bilaterally (n = 14). We used Karl Storz 0 and 30 degrees , 4 mm, 18 cm and 30 cm rod lens rigid endoscope in our dissections. After cadaver preparation, extended endoscopic endonasal approaches were performed to access the cavernous sinus.
In the seven cadavers, the cavernous sinus and superior orbital fissure, on both sides, were widely exposed with extended endoscopic endonasal approach. The antero-inferior portion of the cavernous sinus was exposed by removing the superior and the middle turbinates and the posterior ethmoidal cells (extended endoscopic endonasal transsphenoidal approach); the whole lateral wall of the cavernous sinus was exposed by removing the anterior and the posterior ethmoidal cells (endonasal ethmoido-pterygo-sphenoidal approach: far lateral); and the medial wall of the cavernous sinus was exposed by introducing the 30 degrees endoscope from the contralateral nostril (contralateral endoscopic endonasal transsphenoidal approach). According to the neurovascular architecture, the lateral wall of the cavernous sinus is divided into the superior triangular area, the superior quadrangular area and the inferior quadrangular area. This division can facilitate understanding of the anatomic relations of the cavernous sinus from the endoscopic view.
Knowledge of the anatomy of the cavernous sinus obtained with an endoscopic view of cadaver dissections is an essential step in the learning curve of endoscopic skull base surgery, and is important for endoscopic treatment of various pathologies in this region. In this anatomic study, we reviewed the approaches to the cavernous sinus with an endoscopic view and identified the neurovascular relations. This approach will help in performing safer and minimally invasive surgery.
本研究的目的是认识海绵窦的内镜解剖结构，并了解针对该解剖结构的标准、单纯内镜下经鼻入路。这些基础信息将有助于我们的手术操作并降低手术并发症发生率。
对7具成年新鲜尸体进行双侧研究（n = 14）。解剖过程中我们使用了卡尔·史托斯0度和30度、4毫米、18厘米和30厘米的棒状透镜硬式内镜。尸体准备完成后，采用扩大经鼻内镜入路进入海绵窦。
在这7具尸体中，通过扩大经鼻内镜入路，双侧的海绵窦和眶上裂得以广泛暴露。切除上鼻甲、中鼻甲和后筛窦气房（扩大经鼻内镜经蝶入路）可暴露海绵窦的前下部；切除前筛窦气房和后筛窦气房（经鼻筛骨-翼突-蝶骨入路：远外侧）可暴露海绵窦的整个外侧壁；从对侧鼻孔插入30度内镜（对侧经鼻内镜经蝶入路）可暴露海绵窦的内侧壁。根据神经血管结构，海绵窦的外侧壁可分为上三角区、上四边形区和下四边形区。这种划分有助于从内镜视角理解海绵窦的解剖关系。
通过尸体解剖的内镜视角获得的海绵窦解剖知识是内镜颅底手术学习曲线中的关键一步，对于该区域各种病变的内镜治疗也很重要。在这项解剖学研究中，我们回顾了内镜视角下进入海绵窦的入路并确定了神经血管关系。这种方法将有助于实施更安全、微创的手术。
