The cavernous sinus and middle fossa triangles: contents and clinical importance expanded in 3 dimensions
Introduction: Cavernous sinus and the middle fossa contain neurovascular structures of vital importance for the neurosurgeon. Relations among the cranial nerves and vascular structures have been described, resembling triangular shapes. Material and Methods: Five cadaver heads injected with silicone were dissected. We measured the medial, lateral, and basal aspects of the anteromedial (Dolenc's Triangle), medial, superior, lateral (Parkinson's triangle), posterolateral (Glasscock's triangle), posteromedial (Kawase's triangle), anteromedial and anterolateral triangles. We focused attention to the structures that can be exposed through these areas. Stages of the dissections were recorded with 3-dimensional (3D) photography. Results: We found that dividing the cavernous sinus and the middle fossa into triangular areas is a useful concept to understand the relations among nerves and vascular structures. Most of the triangles can be extended into 3-dimensional polygons, which may allow for refinements in skull base surgical approaches. For example the posteromedial (Kawase) triangle may be extended into a polygon which enhances the space to work in the posterior fossa from a lateral approach. 3D photography adds to the ability to recognize and use the anatomical relationships in the triangles. Conclusion: Knowledge of the anatomy of the cavernous sinus and middle fossa can be gained using triangular figures among the structures. This knowledge can be further enhanced using a 3-dimensional or 3D polygonal approach to the anatomy.
Gonzalez, F; Deshmukh, P; Ferreira, MA; Zabramski, JM; Preul, MC; Spetzler, RF
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