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Lateral orbital wall approach to the cavernous sinus.

Abstract

OBJECT
Lesions of the cavernous sinus remain a technical challenge. The most common surgical approaches involve some variation of the standard frontotemporal craniotomy. Here, the authors describe a surgical approach to access the cavernous sinus that involves the removal of the lateral orbital wall.
METHODS
To achieve exposure of the cavernous sinus, a lateral canthal incision is performed, and the lateral orbital rim and anterior lateral wall are removed, for later replacement at closure. The posterior lateral orbital wall is removed to the region of the superior and inferior orbital fissures. With reflection of the dural covering of the lateral cavernous sinus and removal of the anterior clinoid process, the cavernous sinus is exposed.
RESULTS
Exposure and details of the procedure were derived from anatomical study in cadavers. After the approach, with removal of the anterior clinoid process, the entire cavernous sinus from the superior orbital fissure anteriorly to the Meckel cave posteriorly is exposed. More exposure to the lateral middle fossa, foramen spinosum, and petrous carotid artery is obtained by further removal of the lateral sphenoid wing. An illustrative case example for approaching a cavernous sinus meningioma is presented.
CONCLUSIONS
The translateral orbital wall approach provides a simple, rapid approach for lesions with primary or secondary involvement of the cavernous sinus. Advantages of this simple, extradural approach include the lack of brain retraction and no interruption of the temporalis muscle.

Links

  • Publisher Full Text

    • Authors

    Altay T, Patel BC, Couldwell WT

    Institution

    Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA.

    Source

    Journal of neurosurgery 116:4 2012 Apr pg 755-63

    MeSH

    Aged
    Biopsy
    Cadaver
    Cavernous Sinus
    Craniotomy
    Humans
    Image Enhancement
    Magnetic Resonance Imaging
    Male
    Meningeal Neoplasms
    Meningioma
    Microsurgery
    Nerve Compression Syndromes
    Optic Nerve Diseases
    Orbit
    Surgical Instruments

    Pub Type(s)

    Case Reports
    Journal Article

    Language

    eng

    PubMed ID

    22242672