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Updated: Mar 25, 2026
Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
Endoscopic endonasal study of the cavernous sinus and quadrangular space: Anatomic relationships
Ricardo L L Dolci1,2, Smita Upadhyay1, Leo F S Ditzel Filho3
1Department of Otolaryngology - Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio.
Background:
The quadrangular space permits an anterior entry into Meckel's cave while obviating the need for cerebral or cranial nerve retraction. This avenue is intimately associated with the cavernous sinus; thus, from this ventral perspective, it is feasible to visualize the anteromedial, anterolateral, and Parkinson triangles.
Methods:
Twenty middle cranial fossae were dissected endonasally under direct endoscopic visualization. Measurements of the surface area of the quadrangular space and the ventrally accessible cavernous sinus triangles were performed using 3 coordinates under image-guided navigation.
Results:
The surface area of the quadrangular space was 16.36 mm(2) (±2.89 mm(2) ). The anterolateral triangle was the largest (47.27 ± 5.37 mm(2) ), whereas Parkinson's was the smallest (22.46 ± 5.54 mm(2) ); the anteromedial triangle presented an average surface area 36.07 mm(2) (±4.15 mm(2) ).
Conclusion:
The trajectory of the internal carotid artery (ICA) significantly impacts the quadrangular space area and may be a potential parameter for defining the feasibility of this corridor. © 2016 Wiley Periodicals, Inc. Head Neck 38: E1680-E1687, 2016.
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