■海绵窦(CS)是一个要求苛刻的手术区域,鉴于其位置较深和多个神经血管结构的参与。反复讨论最佳手术入路,最近有人提出内窥镜经眶入路作为选择的外侧CS病变的可行途径。尽管如此,为了使这种技术安全地发展和巩固,对受累颅神经的全面解剖描述,硬脑膜韧带,需要动脉关系。
■CS的详细解剖描述,第三课程,IV,VI,和V脑神经,和颈动脉的C3-C7段,全部从腹外侧内窥镜经眶角度进行描述。
■解剖了五个防腐的人类尸体头(10面)。内窥镜经眶入路切除眶外侧缘,前路临床切除术,并进行了岩石切除术。上颅神经的过程是从它们明显起源于脑干开始的,穿过中窝或海绵窦,直到他们进入轨道。神经导航用于跟踪神经的进程并测量其手术暴露的长度。
■经眶入路使我们能够可视化CS的侧壁,颅神经III,IV,V1-3和VI。前路临床切除术和额硬脑膜和动眼三角的开放显示了III神经的完整进程,平均长度为37(±2)mm。打开三叉神经孔并切割允许跟随IV神经从其围绕脑梗的过程一直到轨道的肌腱,平均54(±4)mm。打开滑车下三角形,在海绵内和Gruber韧带下显示VI神经,扩展的岩石切除术使我们看到了它的脑池部分(27±6毫米)。三叉神经根完全可见,其三个分支也是如此(46±2、34±3和31±1mm,分别)。
■解决CS时需要全面的解剖知识和广泛的外科专业知识。经眶走廊暴露了大部分脑池和受累的颅神经的完整海绵状过程。这篇解剖学文章有助于理解神经的关系,血管,和CS方法中涉及的硬脑膜结构,对于最终完成经眶手术的学习过程至关重要。
UNASSIGNED: The cavernous sinus (CS) is a demanding surgical territory, given its deep location and the involvement of multiple neurovascular structures. Subjected to recurrent discussion on the optimal surgical access, the endoscopic transorbital approach has been recently proposed as a feasible route for selected lesions in the lateral CS. Still, for this technique to safely evolve and consolidate, a comprehensive anatomical description of involved cranial nerves, dural ligaments, and arterial relations is needed.
UNASSIGNED: Detailed anatomical description of the CS, the course of III, IV, VI, and V cranial nerves, and C3-C7 segments of the carotid artery, all described from the ventrolateral endoscopic transorbital perspective.
UNASSIGNED: Five embalmed human cadaveric heads (10 sides) were dissected. An endoscopic transorbital approach with lateral orbital rim removal, anterior clinoidectomy, and petrosectomy was performed. The course of the upper cranial nerves was followed from their apparent origin in the brainstem, through the middle fossa or cavernous sinus, and up to their entrance to the orbit. Neuronavigation was used to follow the course of the nerves and to measure their length of surgical exposure.
UNASSIGNED: The transorbital approach allowed us to visualize the lateral wall of the CS, with cranial nerves III, IV, V1-3, and VI. Anterior clinoidectomy and opening of the frontal dura and the oculomotor triangle revealed the complete course of the III nerve, an average of 37 (±2) mm in length. Opening the trigeminal pore and cutting the tentorium permitted to follow the IV nerve from its course around the cerebral peduncle up to the orbit, an average of 54 (±4) mm. Opening the infratrochlear triangle revealed the VI nerve intracavernously and under Gruber\'s ligament, and the extended petrosectomy allowed us to see its cisternal portion (27 ± 6 mm). The trigeminal root was completely visible and so were its three branches (46 ± 2, 34 ± 3, and 31 ± 1 mm, respectively).
UNASSIGNED: Comprehensive anatomic knowledge and extensive surgical expertise are required when addressing the CS. The transorbital corridor exposes most of the cisternal and the complete cavernous course of involved cranial nerves. This anatomical article helps understanding relations of neural, vascular, and dural structures involved in the CS approach, essential to culminating the learning process of transorbital surgery.