Endoscopic endonasal skull base surgery: Part 2--The cavernous sinus.

Area of Science:

• Neurosurgery
• Endoscopic Skull Base Surgery

Background:

• The cavernous sinus presents complex anatomical challenges for surgical access.
• Developing minimally invasive techniques is crucial for improving patient outcomes.

Observation:

• Cadaveric dissection identified optimal head positioning (horizontal forehead-chin line) for endoscopic endonasal cavernous sinus surgery.
• Three distinct surgical approaches (paraseptal, middle meatal, middle turbinectomy) were defined for accessing the cavernous sinus.
• Detailed anatomical relationships of the carotid siphon and cranial nerves III, IV, VI, and the ophthalmic nerve were elucidated.

Findings:

• The endoscopic endonasal approach provides effective access to the cavernous sinus.
• Different approaches offer varied exposure angles: middle meatal for anterior, paraseptal for anteromedial, and middle turbinectomy for combined ipsilateral/contralateral exposure.
• The technique was found to be minimally invasive in patient treatment, with satisfactory outcomes.

Implications:

• This endoscopic endonasal approach represents a viable, minimally invasive alternative for cavernous sinus surgery.
• The detailed anatomical understanding facilitates safer and more precise surgical interventions.
• Further application of this technique may enhance treatment efficacy and reduce patient morbidity.