By Vinko V. Dolenc M.D., Ph.D. (auth.)
The choice of Harvey Cushing to depart common surgical procedure and focus on the baby box of principal worried method surgical procedure was once on reflection a landmark within the heritage of neurosurgery. His focused paintings, and likewise that of his colleague Walter Dandy, originated with the needs of either pioneers to appreciate surgical anatomy and neurophysiology. the elemental wisdom and surgical techni ques that they supplied turned the normal of excellence for a number of generations of neurosurgeons; quite a bit in order that the final trust used to be that the surgical ideas couldn't be more desirable upon. Twenty-five to thirty years in the past microtechniques started to appear in a couple of surgical learn facilities, they have been then progressively utilized to medical neurosurgery and feature contributed to a brand new point of knowing in surgical anatomy and neurophysiology. we're now lucky to have a brand new commonplace of morbidity and mortality within the surgical operation of intrathecal aneurysms, angiomas, and tumors. it's been acknowledged that microneurosurgery used to be attaining its limits, specially while treating lesions in and round the cavernous sinus and cranium base; these lesions infamous for involvement of the dural and extradural cubicles, with an inclination to infiltrate adjoining nerves and blood vessels. the risks of uncontrollable hemorrhage from the basal sinuses and post-operative CSF rhinorrhea seemed unsurmountable. The lateral facets of the petro-clival zone were of curiosity to a couple pioneering ENT surgeons and neurosurgeons however the cavernous sinus in so much respects has remained the ultimate unconquered summit.
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Extra info for Anatomy and Surgery of the Cavernous Sinus
24. After removal of "venous blood" and slight retraction of the GG, the lateral loop of the ICA can be reached. Thus, the lateral triangle is very important for it gives a safe access to the lateral loop of the ICA Middle cranial fossa subr egio n leA FO 55 leA (LL) FR 56 The surgical triangles of the cavernous sinus Fig. 25. The Vth nerve together with the GG is elevated thereby exposing the lateral loop. In this figure, the entire course of the ICA from the foramen lacerum to the PCP, that is, from the lateral to the medial loop, can be traced.
18. The inner layer of the lateral wall of the CS lying over Vl and V2 has been removed . In this manner the anterolateral triangle is fully exposed. In the anterior part of the anterolateral triangle the fibrous-dural tissue over the bone is intact. The numerous arterial branches supplying the nerves and surrounding structures, as well as "venous blood" in the CS, are shown 43 Middle cram·a I fossa subregion PR FR \\\\\\ \111 GG ~ IV MM DR OA 44 The surgical triangles of the cavernous sinus Fig.
On the lateral border of the oculomotor triangle lie the entry points of the IIIrd and the IVth nerves into the lateral wall of the CS. 27 Parasellar subregion ACP VI IV III Through the oculomotor triangle, the tip of the medial loop of the leA, the medial aspect of the medial loop of the leA, and the medial aspect of the horizontal segment of the leA can be reached. In surgery involving the anteromedial, paramedial or inferomedial triangle, the oculomotor trigone is also usually opened. leA 28 The surgical triangles of the cavernous sinus Fig.