Couldwell W T, Sabit I, Weiss M H, Giannotta S L, Rice D
Department of Surgery, University of North Dakota, Grand Forks, USA.
Neurosurgery. 1997 Jun;40(6):1307-11. doi: 10.1097/00006123-199706000-00040.
Several approaches to expose the anterior cavernous sinus have been used, such as frontotemporal, orbitofrontal, anterior subtemporal, and various transfacial approaches. In an effort to gain exposure to the anterior cavernous sinus without necessitating a craniotomy or wide transfacial exposure, the authors in the present study have developed a transmaxillary approach to the cavernous sinus.
The approach was developed using data obtained by performing 24 cadaveric dissections. Using a sublabial incision to expose the maxilla, maxillotomy is performed and the course of the infraorbital nerve is identified as a guide to the maxillary branch of the trigeminal nerve. After an osteotomy of the posterior sinus wall and pterygoid plate, the foramen rotundum is identified, which lies a mean of 10 mm from the posterior wall of the maxilla. A superomedial enlargement of the foramen rotundum is then undertaken to ultimately expose the anterior cavernous sinus.
This technique offers access to all cavernous cranial nerves, as well as the entire course of the anterior loop of the internal carotid artery to the origin of the ophthalmic artery. With a mean operative range of 38 mm from the posterior wall of the maxilla to the anterior loop of the internal carotid artery, this approach offers adequate exposure with a short operative distance.
The approach may be useful in limited exposure of tumors of the anterior cavernous sinus and some intracavernous vascular lesions.
已采用多种方法暴露海绵窦前部，如额颞部、眶额部、颞下前部及各种经面部入路。为在无需开颅或广泛经面部暴露的情况下暴露海绵窦前部，本研究的作者们开发了一种经上颌入路至海绵窦的方法。
该入路由24例尸体解剖所获数据发展而来。采用唇下切口暴露上颌骨，进行上颌骨切开术，并将眶下神经走行作为三叉神经上颌支的引导标志。在进行后窦壁和翼突板截骨术后，确定圆孔，其距上颌骨后壁平均为10毫米。然后对上颌窦进行超内侧扩大，最终暴露海绵窦前部。
该技术可显露所有海绵窦内的颅神经，以及颈内动脉前环至眼动脉起始处的全程。从距上颌骨后壁至颈内动脉前环的平均手术范围为38毫米，此入路在较短的手术距离下可提供充分暴露。
该入路对于有限暴露海绵窦前部肿瘤及一些海绵窦内血管病变可能有用。
