ABSTRACT
Objectives: Since the pioneering work of Parkinson, several studies have described
the microsurgical anatomy and surgical procedures involving the cavernous sinus (CS).
A proposed geometric construct has been adopted as nomenclature for the region by
many neurosurgeons. However, authors differ in naming and describing some of these
triangular spaces. The purpose of this study is to present the anatomy and measure
the dimensions of the 10 triangles in and around this region. Materials and Methods:
Eighteen CS of five cadaveric heads and four skull bases fixed in formalin were dissected
using 3 × to 40 × magnification of the surgical microscope. The heads and skull bases
were injected with colored silicone and the sides and area of the triangles were measured.
Each cadaveric head was placed in a Sugita head-holder and a cranio-orbitozygomatic
approach and a combined extra- and intradural approach were performed. The last step
was the detachment of the brain from the skull base and measurement of the inferolateral
paraclival and inferomedial paraclival triangles. Results: The measurements of the
medial border, lateral border, and base of each triangle as well as the standard deviation
and area are presented. The posteromedial middle fossa triangle was the largest and
the clinoidal triangle the smallest. Conclusions: The normal anatomy of the CS triangle
and its areas are important in the approach of the CS lesions because these spaces
are natural corridors through which the lesions can be reached. The same concept must
be used for the triangles around this space. Whenever these geometric spaces might
be distorted by pathology or surgical maneuvers, the surgeon must have precise knowledge
about their normal sizes.
KEYWORDS
Cavernous sinus - surgical anatomy - triangles - approaches - internal carotid artery
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Ossama Al-MeftyM.D.
Department of Neurosurgery, University of Arkansas for Medical Sciences
4301 W. Markham Street, #507, Little Rock, AR 72205
Email: KeelandAmyE@uams.edu
