Abstract
The cavernous sinus—classically considered a surgical “no-man’s-land”—can be approached if its surgical anatomy is well known. The cavernous sinus is not a sinus but an interperiosteodural space between the sellar lodge medially and the dura of the temporal fossa laterally. This parasellar lodge is in continuity with the orbit content through the superior orbital fissure. Further, it is not a cavernous structure but is made of venous plexus interconnecting affluents and drainages. It is crossed (together with the abducens nerve) by the internal carotid artery that may be controlled proximally at the foramen lacerum using a subtemporal-extradural petrous apex approach, and distally at the paraclinoid space after an anterior clinoidectomy. The oculomotor, trochlear, and ophthalmic nerves can be dissected free on their traveling within the two layers of the lateral dural wall until the orbit. Noteworthy, the Meckel’s cave, with the trigeminal system inside, is an independent anatomical entity.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
Abbreviations
- ACP:
-
Anterior clinoid process
- APCF:
-
Anterior petroclinoid fold
- CN:
-
Cranial nerves
- CS:
-
Cavernous sinus
- FL:
-
Falciform ligament
- ICA:
-
Internal carotid artery
- ICL:
-
Interclinoidal ligament
- LS:
-
Limbus sphenoidale
- LWSph:
-
Lesser wing of the sphenoid bone
- MCF:
-
Middle cranial fossa
- PCP:
-
Posterior clinoid process
- PG:
-
Pituitary gland
- PPCF:
-
Posterior petroclinoid fold
- PPL:
-
Petrolingual ligament
- SOF:
-
Superior orbital fissure
- SSPL:
-
Superior sphenopetrosal ligament
References
Winsløw JB. (médecin) A du texte. Exposition anatomique de la structure du corps humain, vol. 2. London; 1734.
Taptas JN. The parasellar osteo-dural chamber and the vascular and neural elements that traverse it. An anatomical concept that would replace the cavernous sinus of classical anatomy. Neurochirurgie. 1990;36(4):201–8.
Bonnet P. Cavernous sinus region syndromes. Arch Ophtalmol Rev Gen Ophtalmol. 1955;15(4):357–72.
Parkinson D. A surgical approach to the cavernous portion of the carotid artery. Anatomical studies and case report. J Neurosurg. 1965;23(5):474–83.
Krivosic I. Histoarchitecture of the cavernous sinus. In: Dolenc VV, editor. The cavernous sinus: a multidisciplinary approach to vascular and tumorous lesions [Internet]. Vienna: Springer; 1987. [cited 2021 Aug 29]. p. 117–29. https://doi.org/10.1007/978-3-7091-6982-7_8.
Bedford MA. The “cavernous” sinus. Br J Ophthalmol. 1966;50(1):41–6.
Harris FS, Rhoton AL. Anatomy of the cavernous sinus. A microsurgical study. J Neurosurg. 1976;45(2):169–80.
Taptas JN. The so-called cavernous sinus: a review of the controversy and its implications for neurosurgeons. Neurosurgery. 1982;11(5):712–7.
Lang J. Topographical anatomy of the cranial nerves. In: Samii M, Jannetta PJ, editors. The cranial nerves: anatomy pathology pathophysiology diagnosis treatment [Internet]. Berlin, Heidelberg: Springer; 1981. [cited 2021 Aug 30]. p. 6–15. https://doi.org/10.1007/978-3-642-67980-3_2.
Guyotat J. L’incisure tentorielle. “Les tumeurs de la loge caverneuse / Cavenous sinus tumors”. Sindou, Neurochirurgie, Masson, Paris. 1995;41(3):163–5.
Guyotat J, Bret P, Rémond J, Fischer G. Meningioma of the apex of the tentorial incisura. Diagnostic and surgical aspects apropos of a series of 7 cases. Neurochirurgie. 1991;37(1):12–7.
Bernard F, Mercier P, Sindou M. Morphological and functional anatomy of the trigeminal triangular plexus as an anatomical entity: a systematic review. Surg Radiol Anat SRA. 2019;41(6):625–37.
Sindou M, Brinzeu A. Topography of the pain in classical trigeminal neuralgia: insights into somatotopic organization. Brain J Neurol. 2020;143(2):531–40.
Taptas J. Must we still call cavernous sinus the parasellar vascular and nervous crossroads? The necessity of a definite topographical description of the region. 1987.
Dolenc V. Direct microsurgical repair of intracavernous vascular lesions. J Neurosurg. 1983;58(6):824–31.
Glasscock ME, Miller GW, Drake FD, Kanok MM. Surgery of the skull base. Laryngoscope. 1978;88(6):905–23.
Alaywan M, Sindou M. Fronto-temporal approach with orbito-zygomatic removal. Surg Anatomy Acta Neurochir (Wien). 1990;104(3–4):79–83.
Sindou MP. Working area and angle of attack in three cranial base approaches: pterional, orbitozygomatic, and maxillary extension of the orbitozygomatic approach. Neurosurgery. 2002;51(6). http://journals.lww.com/neurosurgery/Fulltext/2002/12000/Working_Area_and_Angle_of_Attack_in_Three_Cranial.28.aspx
Dolenc VV. The Cavernous Sinus - A multidisciplinary approach to vascular and tumorous lesions | V.V. Dolenc | Springer [Internet]. [cited 2021 Aug 23]. https://www.springer.com/gp/book/9783709174609
Hakuba A, Nishimura S, Shirakata S, Tsukamoto M. Surgical approaches to the cavernous sinus. Neurol Med Chir (Tokyo). 1982;22(4):295–308.
Mullan S. Treatment of carotid-cavernous fistulas by cavernous sinus occlusion. J Neurosurg. 1979;50(2):131–44.
Glasscock ME. A surgical approach to the cavernous portion of the carotid artery. Anatomical studies and case report - PubMed [Internet]. [cited 2021 Aug 23]. https://pubmed.ncbi.nlm.nih.gov/5858438/
Kawase T, Toya S, Shiobara R, Mine T. Transpetrosal approach for aneurysms of the lower basilar artery. J Neurosurg. 1985;63(6):857–61.
Velut S, Jan M. Petrectomy of the point during approach to the clivus: technic, values and limitations. Apropos of a case of meningioma. Neurochirurgie. 1988:17–25.
Sekhar LN, Sen CN, Jho HD, Janecka IP. Surgical treatment of intracavernous neoplasms: a four-year experience. Neurosurgery. 1989;24(1):18–30.
Jacquesson T, Berhouma M, Tringali S, Simon E, Jouanneau E. Which routes for petroclival tumors? A comparison between the anterior expanded endoscopic endonasal approach and lateral or posterior routes. World Neurosurg. 2015;83(6):929–36.
Jacquesson T, Simon E, Berhouma M, Jouanneau E. Anatomic comparison of anterior petrosectomy versus the expanded endoscopic endonasal approach: interest in petroclival tumors surgery. Surg Radiol Anat SRA. 2015;37(10):1199–207.
Samii M, Tatagiba M. Experience with 36 surgical cases of petroclival meningiomas. Acta Neurochir. 1992;118(1–2):27–32.
Zada G, Agarwalla PK, Mukundan S, Dunn I, Golby AJ, Laws ER. The neurosurgical anatomy of the sphenoid sinus and sellar floor in endoscopic transsphenoidal surgery. J Neurosurg. 2011;114(5):1319–30.
Kassam AB, Prevedello DM, Carrau RL, Snyderman CH, Gardner P, Osawa S, et al. The front door to meckel’s cave: an anteromedial corridor via expanded endoscopic endonasal approach- technical considerations and clinical series. Neurosurgery. 2009;64(3 Suppl):ons71–82; discussion ons82–83.
Kassam AB, Gardner P, Snyderman C, Mintz A, Carrau R. Expanded endonasal approach: fully endoscopic, completely transnasal approach to the middle third of the clivus, petrous bone, middle cranial fossa, and infratemporal fossa. Neurosurg Focus. 2005;19(1):E6.
Truong HQ, Lieber S, Najera E, Alves-Belo JT, Gardner PA, Fernandez-Miranda JC. The medial wall of the cavernous sinus. Part 1: surgical anatomy, ligaments, and surgical technique for its mobilization and/or resection. J Neurosurg. 2018;131(1):122–30.
Fernandez-Miranda JC, Zwagerman NT, Abhinav K, Lieber S, Wang EW, Snyderman CH, et al. Cavernous sinus compartments from the endoscopic endonasal approach: anatomical considerations and surgical relevance to adenoma surgery. J Neurosurg. 2018;129(2):430–41.
Sindou M, Messerer M, Alvernia J, Saint-Pierre G. Percutaneous biopsy through the foramen ovale for parasellar lesions: surgical anatomy, method, and indications. Adv Tech Stand Neurosurg. 2012;38:57–73.
Sindou M, Chavez JM, Saint Pierre G, Jouvet A. Percutaneous biopsy of cavernous sinus tumors through the foramen ovale. Neurosurgery. 1997;40(1):106–10; discussion 110–111.
Sindou M, Dumot C. Planning of endocranial supratentorial basal cistern and skull base approaches depending on venous patterns using a topogram. World Neurosurg. 2020;134:365–71.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Ethics declarations
No personal or institutional financial interest in any drugs, materials, or devices.
We hereby confirm that this work has not been published elsewhere in any form.
Conflict of Interest
We hereby confirm that the authors have no conflict of interest in this manuscript.
Rights and permissions
Copyright information
© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Sindou, M., Jacquesson, T. (2023). Surgical Anatomy of the Cavernous Sinus . In: Figueiredo, E.G., Rabelo, N.N., Welling, L.C. (eds) Brain Anatomy and Neurosurgical Approaches . Springer, Cham. https://doi.org/10.1007/978-3-031-14820-0_26
Download citation
DOI: https://doi.org/10.1007/978-3-031-14820-0_26
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-14819-4
Online ISBN: 978-3-031-14820-0
eBook Packages: MedicineMedicine (R0)