Abstract
Despite the advances in skull base techniques, lesions involving cavernous sinus and deeper part of the middle cranial fossa still pose a challenge to neurosurgeons. Even with the advancement of endoscopic instruments, these lesions cannot be completely resected via endoscopic approach and require open surgery. Transcranial approach to this region can be combined with others depending on necessity, for example, anterior clinoidectomy, splitting the lateral wall of cavernous sinus, cutting of tentorium, and anterior petrosectomy. To choose the best approach, we have to ascertain thorough understanding of the involved anatomical structures, clinical symptoms and signs, tumors’ nature, and patients’ expectation. Here, we would like to focus on a standard transcranial approach to the cavernous sinus via the middle cranial fossa approach, its variation to expand the operative corridor to suit different pathology, the technical nuances, and how to avoid major complications.
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References
Guppy KH, Origitano TC, Reichman OH, Segal S. Venous drainage of the inferolateral temporal lobe in relationship to transtemporal/transtentorial approaches to the cranial base. Neurosurgery. 1997;41:615–20.
Hayashi N, Sato H, Tsuboi Y, Nagai S, Kuwayama N, Endo S. Consequences of preoperative evaluation of patterns of drainage of the cavernous sinus in patients treated using anterior transpetrosal approach. Neurol Med Chir (Tokyo). 2010;50:373–7.
Transzygomatic extended middle fossa approach for upper petroclival skull base lesions Neurosurgical Focus. 2008;25(6). https://doi.org/E5-10.3171/FOC.2008.25.12.E5.
Yasargil MG, Reichman MV, Kubik S. Preservation of the frontotemporal branch of the facial nerve using the interfascial temporalis flap for pterional craniotomy. Technical article. J Neurosurg. 1987;67:463–6.
Yoshida K, Kawase T. Zygomatic transpetrosal approach for Dumbbell-shaped parasellar and posterior fossa chordoma. Oper Tech Neurosurg. 2002;5(June):104–7.
Kawase T, van Loveren H, Keller JT, Tew JM. Meningeal architecture of the cavernous sinus: clinical and surgical implications. Neurosurgery. 1996;39:527–34.
Dolenc VV. A combined epi- and subdural direct approach to carotid-ophthalmic artery aneurysm. J Neurosurg. 1985;62:667–72.
Aziz KM, Tew JM Jr, Chicoine MR. The Kawase approach to retrosellar and upper clival basilar aneurysm. Neurosurgery. 1999;44:1225–36.
Altieri R, Zenga F. Detailed anatomy knowledge: first step to approach petroclival meningiomas through the petrous apex. Anatomy lab experience and surgical series. Neurosurg Rev. 2017;40:231–9.
Yasuda A, Campero A, Martins C, Rhoton AL, de Oliveira E, Ribas GC. Microsurgical anatomy and approaches to the cavernous sinus. Neurosurgery 2008;62(6):SHC1240–63: https://doi.org/10.1227/01.NEU.0000333790.90972.59.
Aoyagi M, Ohno K. Combined extradural subtemporal and anterior transpetrosal approach to tumours located in the interpeduncular fossa and the upper clivus. Acta Neurochir (Wien). 2013;155:1401–7.
Tripathi M, Srivastav V. Quantitative analysis of the Kawase versus the modified Dolenc-Kawase approach for middle cranial fossa lesions with variable anteroposterior extension. J Neurosurg. 2015;123:14–22.
Krist AF, Kadri PA. Surgical clip** of complex basilar apex aneurysms: a strategy for successful outcome using the pretemporal transzygomatic transcavernous approach. Neurosurgery. 2005;56(2 Suppl):261–73.
Kawase T, Shiobara R, Toya S. Anterior transpetrosal-transtentorial approach for sphenopetroclival meningiomas: surgical method and results in 10 patients. Neurosurgery. 1991;28:869–76.
Hafez A, Nader R. Preservation of the superior petrosal sinus during the petrosal approach: technical note. J Neurosurg. 2011;114:1294.
Kusumi M, Friedman AH, Fujii K. Tentorial detachment technique in the combined petrosal approach for petroclival meningioma. J Neurosurg. 2012;116:566–73.
Krisht AF. Transcavernous approach to diseases of the anterior upper third of the posterior fossa. Neurosurg Focus. 2005;19(2):E2.
Liao C-H, Chen M-H. Pretemporal trans-Meckel’s cave transtentorial approach for large petroclival meningiomas. Neurosurg Focus. 2018;44(4):E10.
Kobayashi M, Yoshida K, Kawase T. Inter-dural approach to parasellar tumours. Acta Neurochir (Wien). 2010;152:279–85.
Liu JK, Fukushima T, Sameshima T, Al-Mefty O, Couldwell WT. Increasing exposure of the petrous internal carotid artery for revascularization using the transzygomatic extended middle fossa approach: a cadaveric morphometric study. Neurosurgery. 2006;59:ONS309–18.
Siindou M, Wydh E, Jouanneau E, Nebbal M, Lieutaud T. Long-term follow-up of meningiomas of the cavernous sinus after surgical treatment alone. J Neurosurg. 2007;107:937–44.
Couldwell WT, Kan P, Liu JK, Apfelbaum RI. Decompression of cavernous sinus meningioma for preservation and improvement of cranial nerve function. Technical note. J Neurosurg. 2006;105:148–52.
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Cheng, K.F.K., Lui, W.M. (2023). Transcranial Approach to Cavernous Sinus and Middle Cranial Fossa. In: POON, T.L., MAK, C., YUEN, H.K.L. (eds) Orbital Apex and Periorbital Skull Base Diseases. Springer, Singapore. https://doi.org/10.1007/978-981-99-2989-4_18
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