Reconstruction of Cranial Nerves III through VI during Cavernous Sinus Surgery

2015 ◽  
pp. 477-481
Author(s):  
Giuseppe Lanzino ◽  
Laligam N. Sekhar ◽  
Chandra N. Sen ◽  
Spiros Pomonis
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerves ◽  
Sinus Surgery

The Blood Supply of Intracavernous Cranial Nerves: An Anatomic Study and Its Implications for Transcranial and Endoscopic Cavernous Sinus Surgery

2021 ◽  
Author(s):  
Edinson Najera ◽  
Baha'eddin Muhsen ◽  
Bilal Ibrahim ◽  
Michal Obrzut ◽  
Hamid Borghei-Razavi ◽  
...  
Keyword(s):  
Blood Supply ◽  
Cavernous Sinus ◽  
Cranial Nerves ◽  
Sinus Surgery ◽  
Anatomic Study

Reconstruction of the third through sixth cranial nerves during cavernous sinus surgery

1992 ◽  
Vol 76 (6) ◽  
pp. 935-943 ◽  
Author(s):  
Laligam N. Sekhar ◽  
Giuseppe Lanzino ◽  
Chandra N. Sen ◽  
Spiros Pomonis
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Recovery Of Function ◽  
Cranial Nerves ◽  
Sinus Surgery ◽  
Content Type ◽  
The Third ◽  
Successful Recovery ◽  
Cranial Nerve Function ◽  
Fine Print

✓ Sixteen reconstruction procedures of the third through sixth cranial nerves were carried out in 14 patients during operations on 149 tumors involving the cavernous sinus. A direct end-to-end anastomosis was performed in five nerves, whereas in 11 cases the nerve stumps were bridged by means of an interposing nerve graft. The sixth cranial nerve was most frequently reconstructed (nine cases). In four cases, the fifth nerve or root was repaired. The third nerve was reconstructed in two patients, and the fourth nerve was repaired in only one case. Recovery of function, either partial or complete, was observed in 13 nerves: the third in two instances, the fourth in one, the fifth in three, and the sixth in seven. No return of function occurred in three nerves. In patients with a successful recovery of cranial nerve function, either binocular function or the cosmetic result was improved. These results suggest that repair of the third through sixth cranial nerves injured during surgery should be pursued in suitable patients.

scholarly journals Blood Supply of Cranial Nerves Passing Through the Cavernous Sinus: An Anatomical Study and Its Implications for Microsurgical and Endoscopic Cavernous Sinus Surgery

2021 ◽  
Vol 11 ◽  
Author(s):  
Edinson Najera ◽  
Bilal Ibrahim ◽  
Baha’eddin A. Muhsen ◽  
Assad Ali ◽  
Clariza Sanchez ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Blood Supply ◽  
Cavernous Sinus ◽  
Cranial Nerves ◽  
Surgical Techniques ◽  
Anatomical Study ◽  
Distal Segment ◽  
Sinus Surgery ◽  
External Carotid ◽  
Tentorial Artery

BackgroundDespite improvements in surgical techniques, cranial nerve (CN) deficits remain the most frequent cause of disability following cavernous sinus (CS) surgery. The most common tumor affecting the CS is meningioma. They originate from lateral wall and have their blood supply from meningohypophyseal trunk (MHT) and inferolateral trunk (ILT). Pituitary adenomas commonly invade the CS through its medial wall and receive blood supply form medial branches of the internal carotid artery (ICA) (superior and inferior hypophyseal arteries). Some tumors may grow within the CS (e.g. trigeminal schwannomas, hemangiomas). These tumors are fed by all the intracavernous ICA branches. Tumors involving the CS may also displace the neurovascular structures, therefore, a better understanding of intracavernous neurovascular anatomy may reduce the postoperative morbidity associated with approaching CS tumors. In this anatomical study, the anatomic variations and their clinical implications of the intracavernous CNs’ blood supply were evaluated through transcranial and endonasal routes.MethodsTwenty sides of ten adult cadaveric formalin-fixed, latex-injected specimens were dissected in stepwise fashion under microscopic and endoscopic magnification. The origin and course of the intracavernous ICA branches supplying the intracavernous CNs are studied.ResultsThe proximal segment of the oculomotor nerve receives blood supply from the ILT in 85%, and the tentorial artery of the MHT in 15% of specimens. The distal segment is exclusively supplied by the ILT. The proximal trochlear nerve receives blood supply from the ILT (75%) and the tentorial artery (25%); the distal segment is exclusively supplied by the superior orbital branch. The proximal third of the abducens nerve receives its vascularity exclusively from the dorsal meningeal artery, and its middle and distal thirds from the ILT. The ophthalmic and proximal maxillary segments of the trigeminal nerve also receive blood supply from the ILT. The distal maxillary segment is supplied by the artery of the foramen rotundum. All ILT branches terminate on the inferomedial aspects of the intra-cavernous CNs. Extensive anastomoses are found between ILT branches and the branches arising from external carotid artery.ConclusionUnderstanding the anatomy of the intracavernous ICA’s branches is important to improving surgical outcomes with tumors involving the CS.

Cavernous Sinus Surgery—Controversies and Limits

Skull Base ◽  
2005 ◽  
Vol 15 (S 2) ◽  
Author(s):  
Ricardo Ramina ◽  
M. Neto ◽  
Y. Fernandes ◽  
J. Maniglia
Keyword(s):  
Cavernous Sinus ◽  
Sinus Surgery

Zygomatic Approach to Cavernous Sinus Chordoma: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Antonio Aversa ◽  
Ossama Al-Mefty
Keyword(s):  
Carotid Artery ◽  
Cavernous Sinus ◽  
Infratemporal Fossa ◽  
Cranial Nerves ◽  
Radical Resection ◽  
High Rate ◽  
Petrous Apex ◽  
High Dose ◽  
Middle Fossa ◽  
Cavernous Carotid Artery

Abstract Chordoma is not a benign disease. It grows invasively, has a high rate of local recurrence, metastasizes, and seeds in the surgical field.1 Thus, chordoma should be treated aggressively with radical resection that includes the soft tissue mass and the involved surrounding bone that contains islands of chordoma.2–5 High-dose radiation, commonly by proton beam therapy, is administered after gross total resection for long-term control. About half of chordoma cases occupy the cavernous sinus space and resecting this extension is crucial to obtain radical resection. Fortunately, the cavernous sinus proper extension is the easier part to remove and pre-existing cranial nerves deficit has good chance of recovery. As chordomas originate and are always present extradurally (prior to invading the dura), an extradural access to chordomas is the natural way for radical resection without brain manipulation. The zygomatic approach is key to the middle fossa, cavernous sinus, petrous apex, and infratemporal fossa; it minimizes the depth of field and is highly advantageous in chordoma located mainly lateral to the cavernous carotid artery.6–12 This article demonstrates the advantages of this approach, including the mobilization of the zygomatic arch alleviating temporal lobe retraction, the peeling of the middle fossa dura for exposure of the cavernous sinus, the safe dissection of the trigeminal and oculomotor nerves, and total control of the petrous and cavernous carotid artery. Tumor extensions to the sphenoid sinus, sella, petrous apex, and clivus can be removed. The patient is a 30-yr-old who consented for surgery.

The So-Called Cavernous Sinus: A Review of the Controversy and Its Implications for Neurosurgeons

Neurosurgery ◽  
1982 ◽  
Vol 11 (5) ◽  
pp. 712-717 ◽  
Author(s):  
John N. Taptas
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Cranial Nerves ◽  
Sella Turcica ◽  
Middle Cranial Fossa ◽  
Cranial Fossa ◽  
Base Of The Skull ◽  
Extradural Space

Abstract The so-called cavernous sinus is a venous pathway, an irregular network of veins that is part of the extradural venous network of the base of the skull, not a trabeculated venous channel. This venous pathway, the internal carotid artery, and the oculomotor cranial nerves cross the medial portion of the middle cranial fossa in an extradural space formed on each side of the sella turcica by the diverging aspects of a dural fold. In this space the venous pathway has only neighborhood relations with the internal carotid artery and the cranial nerves. The space itself must be distinguished from the vascular and nervous elements that it contains. The revision of the anatomy of this region has not only theoretical interest but also important clinical implications.

scholarly journals Septic Cavernous Sinus Thrombosis due to Pneumococcal Meningitis in A 6 Months Infant

2021 ◽  
Author(s):  
Kauan Alves Sousa Madruga ◽  
Luiz Fernando Melo Lima ◽  
Pedro Victor Oliveira Araújo ◽  
Vitória Bittencourt de Carvalho ◽  
Bruna Da Cruz Beyruth Borges
Keyword(s):  
Cavernous Sinus ◽  
Pneumococcal Meningitis ◽  
Sinus Thrombosis ◽  
Thrombus Formation ◽  
Cranial Nerves ◽  
Cavernous Sinus Thrombosis ◽  
Infection Focus ◽  
History Of ◽  
Eye Opening ◽  
Clinical Thinking

Context: Septic Cavernous Sinus Thrombosis (CST) is a rare and potentially lethal illness that clinicians still occasionally see. We describe the evolution of a 6 months old infant patient who had a history of delayed vaccination and acquired a Pneumococcal Meningitis, leading to septic CTS. Case report: The patient was admitted with the complaint of constant crying and vomiting. The physical exam noticed: bulging of the bregmatic fontanelle, Glasgow Coma Score = 11, and bad general state. The clinical picture had begun one week before the hospitalization, but the fever had started just three days before. The vaccine neglection plus some pathological signs of meningeal infection guided the clinical thinking to meningitis, later confirmed by the lumbar puncture. Some days later, the patient presented paralysis of the third pair of cranial nerves, conducing to the inability to open the eyes, mydriatic non-photo reagent pupils, and bilateral swelling. A magnetic resonance confirmed thrombosis of traverse sinus along with the transition to the sigmoid one. Bilateral ptosis and exotropia were noticed. Antibiotic therapy resulted in progressive eye-opening and recurrence of photo reagent reflexes. The prognosis was great, pointed by the normotension and normal amplitude of the bregmatic fontanelle. Conclusion: The elimination of the meningeal infection focus was extremely important, since the pathophysiology of CST came from phlebitis of the cavernous sinuses, with consequent thrombus formation from the endothelial lesion. In addition, it is worth mentioning the omission of vaccination, which was concessive to the case.

Dose—response tolerance of the visual pathways and cranial nerves of the cavernous sinus to stereotactic radiosurgery

1998 ◽  
Vol 88 (1) ◽  
pp. 43-50 ◽  
Author(s):  
Klaus A. Leber ◽  
Jutta Berglöff ◽  
Gerhard Pendl
Keyword(s):  
Stereotactic Radiosurgery ◽  
Cavernous Sinus ◽  
Dose Response ◽  
Cranial Nerves ◽  
Visual Pathways ◽  
Content Type ◽  
Number Of Patients ◽  
Response Tolerance ◽  
Fine Print

As the number of patients treated with stereotactic radiosurgery increases, it becomes particularly important to define with precision adverse effects on distinct structures of the nervous system. Object. This study was designed to assess the dose—response tolerance of the visual pathways and cranial nerves after exposure of the cavernous sinus to radiation. Methods. A total of 66 sites in the visual system and 210 cranial nerves of the middle cranial fossa were investigated in 50 patients who had undergone gamma knife treatment for benign skull base tumors. The mean follow-up period was 40 months (range 24–60 months). Follow-up examinations consisted of neurological, neuroradiological, and neuroophthalmological evaluations. The actuarial incidence of optic neuropathy was zero for patients who received a radiation dose of less than 10 Gy, 26.7% for patients receiving a dose in the range of 10 to less than 15 Gy, and 77.8% for those who received doses of 15 Gy or more (p < 0.0001). Previously impaired vision improved in 25.8% and was unchanged in 51.5% of patients. No sign of neuropathy was seen in patients whose cranial nerves of the cavernous sinus received radiation doses of between 5 and 30 Gy. Because tumor control appeared to have been achieved in 98% of the patients, the deterioration in visual function cannot be attributed to tumor progression. Conclusions. The structures of the visual pathways (the optic nerve, chiasm, and tract) exhibit a much higher sensitivity to single-fraction radiation than other cranial nerves, and their particular dose—response characteristics can be defined. In contrast, the oculomotor and trigeminal nerves have a much higher dose tolerance.

scholarly journals Endoscopic Endonasal Cavernous Sinus Surgery: An Anatomic Study

Neurosurgery ◽  
2001 ◽  
Vol 49 (5) ◽  
pp. 1271-1272 ◽  
Author(s):  
Ibrahim M. Ziyal ◽  
Tunçalp Özgen
Keyword(s):  
Cavernous Sinus ◽  
Sinus Surgery ◽  
Anatomic Study ◽  
Endoscopic Endonasal

scholarly journals Safe maximal resection of primary cavernous sinus meningiomas via a minimal anterior and posterior combined transpetrosal approach

2018 ◽  
Vol 44 (4) ◽  
pp. E11 ◽  
Author(s):  
Hiroki Morisako ◽  
Takeo Goto ◽  
Hiroki Ohata ◽  
Sachin Ranganatha Goudihalli ◽  
Keisuke Shirosaka ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerves ◽  
Previous Treatment ◽  
Extent Of Resection ◽  
Karnofsky Performance Scale ◽  
Prepontine Cistern ◽  
Suboccipital Craniotomy ◽  
Ocular Movements ◽  
Visual Access ◽  
Scale Scores

OBJECTIVEMeningiomas arising from the cavernous sinus (CS) continue to be a significant technical challenge, and resection continues to carry a relatively higher risk of neurological morbidity in patients with these lesions because of the tumor’s proximity to neurovascular structures. The authors report the surgical outcomes of 9 patients with primary CS meningiomas (CSMs) that were surgically treated using a minimal anterior and posterior combined (MAPC) transpetrosal approach, and they emphasize the usefulness of the approach.METHODSThis retrospective study included 9 patients who underwent surgery for CSM treatment between 2015 and 2016 via the MAPC transpetrosal approach. Two patients were men and 7 were women, with a mean age of 58.5 years (39–72 years). Five patients (55.5%) had undergone previous treatment. The surgical technique consisted of a temporo-occipito-suboccipital craniotomy and exposure of the posterolateral part of the CS via the presigmoidal MAPC approach. After opening Meckel’s cave and identifying the 3rd–5th cranial nerves in the prepontine cistern, Parkinson’s triangle and supratrochlear triangles were opened. Finally, the tumor occupying the posterolateral part of the CS was removed.RESULTSAll lesions were safely and maximally removed, with preservation of external ocular movements and preoperative Karnofsky Performance Scale scores. The mean extent of resection was 77.0% (range 58.7%–95.4%). Six patients underwent adjuvant therapy in the form of stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT) during the follow-up period; none of these patients experienced recurrence.CONCLUSIONThe authors conclude that the MAPC transpetrosal approach could be superior to other approaches for CSMs, as it provides direct visual access to the posterolateral portion of the CS. In their experience, this approach is an alternative and better option for safe maximal resection of CSMs.

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