"Sagittal Crest": Definition, Stepwise Dissection, and Clinical Implications From a Transorbital Perspective

Area of Science:

• Neurosurgery
• Anatomy
• Endoscopic Surgery

Background:

• The superior eyelid endoscopic transorbital approach (SETOA) is a novel surgical route for managing tumors in the cavernous sinus and middle cranial fossa.
• A consistent anatomical landmark, the

Purpose of the Study:

• To conduct an anatomical investigation to define the surgical landmark known as the
• Main_Methods

Main Methods:

• Dissection of four adult cadaveric specimens (8 sides) using an endoscopic transorbital approach.
• Removal of the sagittal crest (SC) to facilitate interdural opening of the cavernous sinus.
• Pre- and post-dissection CT scans for quantitative analysis and 3D modeling of bone resection.

Main Results:

• The sagittal crest (SC) is a triangular bone ridge located dorsally to the superior orbital fissure, formed from the residual greater sphenoid wing (GSW).
• CT scans objectively assessed SC dimensions (mean 1.08 ± 0.2 cm).

Conclusions:

• The sagittal crest (SC) is a constant anatomical landmark, representing the remaining medial part of the greater sphenoid wing (GSW).
• Complete resection of the SC is mandatory in SETOA for adequate surgical working space and to guide dissection of the cavernous sinus lateral wall.