Surgical Approaches to the Cavernous Sinus from Anatomical Viewpoint

Abstract

With regard to neurosurgical techniques, the cavernous sinus (CS) is one of the most inaccessible areas. Ten adult cadaveric cavernous sinus were examined in detail to evaluate the surgically important relationships of the blood vessels and cranial nerves in the cavernous sinus.
Cranial nerves (CN) III, IV & V_1,2 were embedded in a deep dural layer of the CS and were supplied by the two main branches of the internal carotid artery. The meningohypophyseal artery gave branches to the CN VI in Dorello's canal and the CN V at the dural entrance area. The inferolateral trunk supplied the CN III, IV & V. The capsular artery did not take part in the blood supply to the CN.
In the rectangular space between the CN III and posterior clinoid process after the removal of the anterior clinoid gave access to the C₃ & C₄ portion of the intracavernous carotid artery without sacrificing cranial nerves. In the lateral wall, the size of the triangular space between the CN III, IV & V varied. The intracavernous carotid artery and some of its branches through the lateral wall had a potential risk of injury to the CN III, IV & VI.
The importance of each of these neurovascular structures in various surgical approaches to the cavernous sinus are discussed in this paper.