Cavernous Sinus Access via the Translateral Orbital Wall Approach

Introduction: Access to the cavernous sinus remains a major technical challenge. The Dolenc approach and its variations involve transcranial drilling and some degree of dural mobilization and brain retraction. Altay et al have proposed a new approach via a lateral orbital wall. We describe our experience with this approach in vascularized cadaver models.

Methods: A modified version of the Aboud vascularized cadaver model was used with Thiel embalmed heads and artificial venous, arterial, and CSF circulation. A Berke canthal incision was used to expose the orbital rim, which was resected along with the lateral wall. A posterior corridor was created and the anterior clinoid process was removed, gaining ample access to the cavernous sinus and Meckel's cave. Blood pressure elevation was used to induce brisk bleeding to test the feasibility of the approach. Operative positioning, duration, ergonomics, and safety were assessed.

Results: The work of Altay et al was replicated without difficulty, and venous bleeding was controllable in all stages. The angle of approach was satisfactory for cavernous sinus exploration, and orbital reconstruction was achieved with good cosmetic results. Sphenoid wing drilling allowed further exposure of the petrous carotid artery and other middle fossa anatomy.

Conclusion: The new translateral approach to the cavernous sinus is a feasible and fast corridor to cavernous sinus lesions. This extradural pathway involves no brain retraction and yields good orbital reconstruction postoperatively.