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The antero-medial triangle: the risk for cranial nerves ischemia at the cavernous sinus lateral wall. Anatomic cadaveric study.
Clin Neurol Neurosurg. 2008 Jul; 110(7):682-6.CN

Abstract

OBJECTIVE

Vascular damage in the cavernous sinus can cause ischemic injury to the cranial nerves. An appropriate anatomical knowledge of the blood supply to the cranial nerves can help to reduce the morbidity associated with cavernous sinus surgery.

MATERIAL AND METHODS

Three formalin-fixed and six adult cadaveric fresh heads, with common carotid arteries injected, were used for anatomical dissection in this study. A fronto-temporal craniotomy was performed and the cavernous sinus was explored according to the Dolenc technique. With microsurgical dissection and photographic documentation, we demonstrate the anatomy of the superior orbital fissure artery in the antero-medial triangle.

RESULTS

The 12 explored cavernous sinuses demonstrated the presence of two principal branches directly from the intracavernous internal carotid artery that supply the cranial nerves: the infero-lateral trunk and the meningohypophyseal trunk. The artery of the Superior Orbital Fissure (SOF), originated more often from the infero-lateral trunk, and vascularized the III, IV, VI, and VI, and ophtalmic division of the trigeminal nerve (TGN VI) at their entry in the fissure.

CONCLUSION

In this study we demonstrate that the superior orbital fissure artery is a branch from the infero-lateral trunk which runs immediately under the reticularis layer at the level of the anteromedial triangle in the lateral wall of the cavernous sinus. The blood supply to all cranial nerves in the SOF is at risk to injury when the lateral wall of the cavernous sinus is transgressed at the anteromedial triangle since the SOF-artery runs superficially at this level.

Authors+Show Affiliations

Section of Neurological Surgery of Bolzano, Italy. micheleconti@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18554776

Citation

Conti, M, et al. "The Antero-medial Triangle: the Risk for Cranial Nerves Ischemia at the Cavernous Sinus Lateral Wall. Anatomic Cadaveric Study." Clinical Neurology and Neurosurgery, vol. 110, no. 7, 2008, pp. 682-6.
Conti M, Prevedello DM, Madhok R, et al. The antero-medial triangle: the risk for cranial nerves ischemia at the cavernous sinus lateral wall. Anatomic cadaveric study. Clin Neurol Neurosurg. 2008;110(7):682-6.
Conti, M., Prevedello, D. M., Madhok, R., Faure, A., Ricci, U. M., Schwarz, A., Robert, R., & Kassam, A. B. (2008). The antero-medial triangle: the risk for cranial nerves ischemia at the cavernous sinus lateral wall. Anatomic cadaveric study. Clinical Neurology and Neurosurgery, 110(7), 682-6. https://doi.org/10.1016/j.clineuro.2008.04.007
Conti M, et al. The Antero-medial Triangle: the Risk for Cranial Nerves Ischemia at the Cavernous Sinus Lateral Wall. Anatomic Cadaveric Study. Clin Neurol Neurosurg. 2008;110(7):682-6. PubMed PMID: 18554776.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The antero-medial triangle: the risk for cranial nerves ischemia at the cavernous sinus lateral wall. Anatomic cadaveric study. AU - Conti,M, AU - Prevedello,D M, AU - Madhok,R, AU - Faure,A, AU - Ricci,U M, AU - Schwarz,A, AU - Robert,R, AU - Kassam,A B, Y1 - 2008/06/12/ PY - 2007/10/08/received PY - 2008/03/31/revised PY - 2008/04/05/accepted PY - 2008/6/17/pubmed PY - 2008/9/16/medline PY - 2008/6/17/entrez SP - 682 EP - 6 JF - Clinical neurology and neurosurgery JO - Clin Neurol Neurosurg VL - 110 IS - 7 N2 - OBJECTIVE: Vascular damage in the cavernous sinus can cause ischemic injury to the cranial nerves. An appropriate anatomical knowledge of the blood supply to the cranial nerves can help to reduce the morbidity associated with cavernous sinus surgery. MATERIAL AND METHODS: Three formalin-fixed and six adult cadaveric fresh heads, with common carotid arteries injected, were used for anatomical dissection in this study. A fronto-temporal craniotomy was performed and the cavernous sinus was explored according to the Dolenc technique. With microsurgical dissection and photographic documentation, we demonstrate the anatomy of the superior orbital fissure artery in the antero-medial triangle. RESULTS: The 12 explored cavernous sinuses demonstrated the presence of two principal branches directly from the intracavernous internal carotid artery that supply the cranial nerves: the infero-lateral trunk and the meningohypophyseal trunk. The artery of the Superior Orbital Fissure (SOF), originated more often from the infero-lateral trunk, and vascularized the III, IV, VI, and VI, and ophtalmic division of the trigeminal nerve (TGN VI) at their entry in the fissure. CONCLUSION: In this study we demonstrate that the superior orbital fissure artery is a branch from the infero-lateral trunk which runs immediately under the reticularis layer at the level of the anteromedial triangle in the lateral wall of the cavernous sinus. The blood supply to all cranial nerves in the SOF is at risk to injury when the lateral wall of the cavernous sinus is transgressed at the anteromedial triangle since the SOF-artery runs superficially at this level. SN - 0303-8467 UR - https://www.unboundmedicine.com/medline/citation/18554776/The_antero_medial_triangle:_the_risk_for_cranial_nerves_ischemia_at_the_cavernous_sinus_lateral_wall__Anatomic_cadaveric_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0303-8467(08)00129-7 DB - PRIME DP - Unbound Medicine ER -