Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA.
Rosa Ella Burkhardt Brain Tumor Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.
World Neurosurg. 2022 Mar;159:e139-e160. doi: 10.1016/j.wneu.2021.12.023. Epub 2021 Dec 11.
The parasellar region is one of the most complex of the skull base. In this study, we review the anatomy and approaches to this region through a 360° perspective, correlating microsurgical and endoscopic anatomic nuances of this area.
An endoscopic endonasal approach (EEA) and microsurgical dissections were performed. The parasellar anatomy is reviewed and common areas of tumor extensions are assessed. Surgical approaches are discussed based on the anatomic nuances of those regions.
The cavernous sinus (CS) can be divided into 2 spaces: posterosuperior, above and behind the internal carotid artery (ICA); and anterior, in front of the cavernous ICA. Those spaces can be approached through the CS walls: anterior and/or medial wall via EEA; or superior and/or lateral wall via transcranial approaches. The relationship of the Meckel cave, adjacent to the lateral and posterior wall of the CS, is relevant for surgical planning. Areas often affected by tumor extension can be divided into 6 regions: superior (cisternal), superolateral (parapeduncular), posterolateral (Meckel cave and petrous bone), medial (sella), anterior (superior orbital fissure), and anterior inferior (pterygopalatine fossa). Anatomic and technical nuances of each of those regions should be taken into consideration when dealing with tumors in the parasellar space.
A transcranial approach and EEA provide effective access to the parasellar region. Management of cavernous sinus and Meckel cave tumors requires familiarity with those approaches. Understanding of the surgical anatomy of the parasellar region, from above and below, is therefore necessary for adequate surgical planning and execution.
鞍旁区是颅底最复杂的区域之一。在本研究中，我们通过 360°视角回顾了该区域的解剖结构和入路，将该区域的显微外科和内镜解剖学细节联系起来。
进行了内镜经鼻入路（EEA）和显微外科解剖。复习了鞍旁解剖结构，并评估了常见肿瘤延伸部位。根据这些区域的解剖学细节讨论了手术入路。
海绵窦（CS）可分为 2 个腔：位于颈内动脉（ICA）上方和后方的后上腔；位于海绵窦ICA 前方的前腔。这些腔可以通过 CS 壁进行入路：通过 EEA 经前壁和/或内侧壁；或通过经颅入路经上壁和/或外侧壁。毗邻 CS 外侧和后壁的 Meckel 腔的关系对于手术规划很重要。肿瘤常侵犯的区域可分为 6 个区域：上（池）、上外侧（脚间池）、后外侧（Meckel 腔和岩骨）、内侧（鞍内）、前上（眶上裂）和前下（翼腭窝）。处理鞍旁区肿瘤时，应考虑到这些区域的解剖学和技术细节。
经颅入路和 EEA 为鞍旁区提供了有效的入路。海绵窦和 Meckel 腔肿瘤的处理需要熟悉这些入路。因此，为了进行充分的手术规划和执行，有必要从上至下理解鞍旁区的手术解剖结构。
