Endoscopic endonasal study of the cavernous sinus and quadrangular space: Anatomic relationships

Area of Science:

• Neurosurgery
• Endoscopic Skull Base Surgery

Background:

• The quadrangular space provides anterior access to Meckel's cave, avoiding brain or cranial nerve retraction.
• This approach is linked to the cavernous sinus, allowing visualization of key triangles from a ventral perspective.

Purpose of the Study:

• To assess the anatomical feasibility of the quadrangular space and associated triangles for endoscopic endonasal surgery.
• To quantify the surface areas of the quadrangular space and cavernous sinus triangles.

Main Methods:

• Twenty middle cranial fossae underwent endoscopic endonasal dissection.
• Surface areas were measured using image-guided navigation coordinates.

Main Results:

• The quadrangular space averaged 16.36 mm².
• The anterolateral triangle was largest (47.27 mm²), Parkinson's triangle smallest (22.46 mm²), and anteromedial triangle measured 36.07 mm².

Conclusions:

• The internal carotid artery's trajectory influences quadrangular space dimensions.
• This corridor's feasibility may depend on ICA trajectory, offering a novel surgical route.