The Medial Extra-Sellar Corridor to the Cavernous Sinus: Anatomic Description and Clinical Correlation

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• 作者：Philip V. Theodosopoulos⁵ ; Helene Cebula⁶ ; Almaz Kurbanov¹ ; Arnau Benet Cabero⁵ ; Joseph A. Osorio⁵ ; Lee A. Zimmer² ; ³ ; Sebastien C. Froelich⁶ ; Jeffrey T. Keller¹ ; ³ ; ⁴ ; ^{mary.kemper@uc.edu}
• 关键词：Anatomic study ; Cavernous sinus ; Endoscopic endonasal approaches ; Lateral sellar compartment ; Medial corridor ; Surgical triangles
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：96
• 期：Complete
• 页码：417-422
• 全文大小：1376 K
• 卷排序：96

文摘

The zenith of surgical interest in the cavernous sinus peaked in the 1980s, as evidenced by reports of 10 surgical triangles that could access the contents of the lateral sellar compartment (LSC). However, these transcranial approaches later became marginalized, first by radiosurgery's popularity and lower morbidity, and then by clinical potential of endoscopic corridors noted in several qualitative studies. Our anatomic study, taking a contemporary look at the medial extra-sellar corridor, gives a detailed qualitative-quantitative analysis for its use with increasingly popular endoscopic endonasal approaches to the cavernous sinus.MethodsIn 20 cadaveric specimens, we re-examined the anatomic landmarks of the medial corridor into the LSC with qualitative descriptions and measurements. An illustrative case highlights a recurrent symptomatic pituitary adenoma that invaded the cavernous sinus approached through the medial corridor.ResultsThe corridor's shape varied from tetrahedron to hexahedron. Comparing right and left sides, width averaged 3.6 ± 4.5 mm and 4.0 ± 4.4 mm, and height averaged 2.3 mm and 2.1 mm, respectively. About 35% of sides showed ample space for access into the cavernous sinus. Our case report of successful outcome lends support for the safety and efficacy of this endoscopic approach.ConclusionsOur re-examination of this particular surgical access into the LSC refines the understanding of the medial extra-sellar corridor as a main endoscopic access route to this compartment. Achieving safe access to the contents of the LSC, this 11th triangle is clinically relevant and potentially superior for select lesions in this region.