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[Anatomic rationale for a transmaxillary access to the cavernous sinus].
Zhurnal Voprosy Neirokhirurgii Imeni N. N. Burdenko
|July 11, 2006
Summary
This study evaluates the transmaxillary approach for accessing the cavernous sinus, demonstrating its low-trauma potential for specific skull base pathologies. The technique offers a deep, narrow corridor suitable for limited lesion removal, with endoscopic assistance enhancing visualization.
Area of Science:
- Neurosurgery
- Anatomy
- Surgical Access
Context:
- The transmaxillary approach to the cavernous sinus, first proposed in 1997, offers a minimally invasive and cosmetic alternative for visualizing neurovascular structures.
- Understanding the microsurgical anatomy and simulating this approach is crucial for its safe and effective application.
Purpose:
- To investigate the microsurgical anatomy of the transmaxillary approach.
- To simulate the surgical access and assess its feasibility.
- To evaluate the utility of endoscopic techniques in conjunction with this approach.
Summary:
- Craniometric analysis of 33 skulls and 25 craniograms informed the anatomical parameters of the transmaxillary access.
- Simulations on skull models and cadaveric dissections (5 sides) refined the surgical technique, including maxillotomy and bone drilling around the foramen rotundum.
- The study defined boundaries for bone removal at the skull base and explored visualization of the infratemporal and pterygopalatine fossae, as well as the lower cavernous sinus.
Impact:
- The transmaxillary approach is a deep, narrow, and low-traumatic corridor.
- It is suitable for removing small pathologies in the pterygopalatine fossa, foramen rotundum, or lower cavernous sinus.
- While providing confidence in retromaxillary space surgery, it lacks direct guidance of the internal carotid artery and is not ideal for intradural abnormalities.