Abstract
Purpose
The parasellar region is a small but complex structure, and a large variety of tumors arise from this region. Postoperative morbidity for these tumors depends significantly on the cranial nerves located in the lateral part of this parasellar region. The aim of this study is to understand the anatomical structures of the lateral parasellar region and describe the inter-dural approach for parasellar tumors.
Methods
To understand the anatomical structure, microsurgical dissection of both sides of six cadaveric heads and histological study of three cadaveric heads were performed. Based on our findings, a less invasive, inter-dural approach is demonstrated with our experiences of cases with parasellar tumors.
Results
The dura mater of the middle cranial fossa consists of periosteal and meningeal dura. In the parasellar region (medial to trigeminal nerve branches), these two layers are separated, composing an inter-dural space. The cranial nerves, cavernous sinus and carotid artery are located in this inter-dural space. Cranial nerves are surrounded by a membrane, a so-called inner layer. The cavernous sinus is separated from the cranial nerves by this inner layer. It is an important notion that a periosteal incision along the inferior margin of the cavernous sinus in the middle cranial fossa allows an approach to the trigeminal nerve and cavernous sinus without intrusion into the subdural space and injury of nerves and vessels.
Conclusions
Considering anatomical and histological study and our clinical experiences, this inter-dural approach is practicable and useful for surgical removal of the tumors such as trigeminal neurinoma and cavernous hemangioma.
Similar content being viewed by others
References
Abdel-Aziz KM, Froelich SC, Dagnew E, Jean W, Breneman JC, Zuccarello M, van Loveren HR, Tew JM Jr (2004) Large sphenoid wing meningiomas involving the cavernous sinus: conservative surgical strategies for better functional outcomes. Neurosurgery 54:1375–1384
Asbury AK (1982) Peripheral nerves. In: Haymaker W, Adams RD (eds) Histology and Histopathology of the Nervous System. Charles C. Thomas, Springfield, pp 1566–1570
Couldwell WT, Kan P, Liu JK, Apfelbaum RI (2006) Decompression of cavernous sinus meningioma for preservation and improvement of cranial nerve function. Technical note. J Neurosurg 105:148–152
Dolenc VV (1994) Frontotemporal epidural approach to trigeminal neurinomas. Acta Neurochir (Wien) 130:55–65
Dolenc VV, Rogers L (2003) Microsurgical Anatomy and Surgery of the Central Skull Base. Springer WienNewYork, pp 3–70, 253–272
Eisenberg MB, Al-Mefty O, DeMonte F, Burson GT (1999) Benign nonmeningeal tumors of the cavernous sinus. Neurosurgery 44:949–955
Fraioli B, Esposito V, Santoro A, Iannetti G, Giuffre R, Cantore G (1995) Transmaxillosphenoidal approach to tumors invading the medial compartment of the cavernous sinus. J Neurosurg 82:63–69
Goel A, Muzumdar DP, Nitta J (2001) Surgery on lesions involving cavernous sinus. J Clin Neurosci 8(Suppl 1):71–77
Iwai Y, Yamanaka K, Ishiguro T (2003) Gamma knife radiosurgery for the treatment of cavernous sinus meningiomas. Neurosurgery 52:517–524
Kawase T, van Loveren H, Keller JT, Tew JM (1996) Meningeal architecture of the cavernous sinus: clinical and surgical implications. Neurosurgery 39:527–536
Kuo JS, Chen JC, Yu C, Zelman V, Giannotta SL, Petrovich Z, MacPherson D, Apuzzo ML (2004) Gamma knife radiosurgery for benign cavernous sinus tumors: quantitative analysis of treatment outcomes. Neurosurgery 54:1385–1394
Lee JY, Niranjan A, McInerney J, Kondziolka D, Flickinger JC, Lunsford LD (2002) Stereotactic radiosurgery providing long-term tumor control of cavernous sinus meningiomas. J Neurosurg 97:65–72
Maruyama K, Shin M, Kurita H, Kawahara N, Morita A, Kirino T (2004) Proposed treatment strategy for cavernous sinus meningiomas: a prospective study. Neurosurgery 55:1068–1075
Metellus P, Regis J, Muracciole X, Fuentes S, Dufour H, Nanni I, Chinot O, Martin PM, Grisoli F (2005) Evaluation of fractionated radiotherapy and gamma knife radiosurgery in cavernous sinus meningiomas: treatment strategy. Neurosurgery 57:873–886
Nicolato A, Foroni R, Alessandrini F, Bricolo A, Gerosa M (2002) Radiosurgical treatment of cavernous sinus meningiomas: experience with 122 treated patients. Neurosurgery 51:1153–1161
Nicolato A, Foroni R, Alessandrini F, Maluta S, Bricolo A, Gerosa M (2002) The role of gamma knife radiosurgery in the management of cavernous sinus meningiomas. Int J Radiat Oncol Biol Phys 53:992–1000
Parent A (1996) Carpenter’s Human Neuroanatomy, 9th edn. Williams & Wilkins, Baltimore, pp 264–268
Ozveren MF, Uchida K, Aiso S, Kawase T (2002) Meningovenous structures of the petroclival region: clinical importance for surgery and intravascular surgery. Neurosurgery 50:829–837
Romanes GJ (1981) The peripheral nervous system. In: Romanes GJ (ed) Cunningham’s Textbook of Anatomy, 12th edn. Oxford University Press, Oxford, pp 739–740
Shanthaveerappa TR, Bourne GH (1966) Perineural epithelium: A new concept of its role in the integrity of the peripheral nervous system. Science 154:1464–1467
Suri A, Ahmad FU, Mahapatra AK (2007) Extradural transcavernous approach to cavernous sinus hemangiomas. Neurosurgery 60:483–489
Taptas JN (1982) The so-called cavernous sinus: A review of the controversy and it implications for neurosurgeons. Neurosurgery 11:712–717
Yasuda A, Campero A, Martins C, Rhoton AL Jr, Ribas GC (2004) The medial wall of the cavernous sinus: microsurgical anatomy. Neurosurgery 55:179–190
Yonekawa Y, Ogata N, Imhof HG, Olivecrona M, Strommer K, Kwak TE, Roth P, Groscurth P (1997) Selective extradural anterior clinoidectomy for supra- and parasellar processes. Technical note. J Neurosurg 87:636–642
Youssef S, Kim EY, Aziz KM, Hemida S, Keller JT, van Loveren HR (2006) The Subtemporal Interdural Approach to Dumbbell-shaped Trigeminal Schwannomas: Cadaveric Prosection. Neurosurgery 59 (4 Suppl 2):ONS270-ONS278
Author information
Authors and Affiliations
Corresponding author
Additional information
Rights and permissions
About this article
Cite this article
Kobayashi, M., Yoshida, K. & Kawase, T. Inter-dural approach to parasellar tumors. Acta Neurochir 152, 279–285 (2010). https://doi.org/10.1007/s00701-009-0515-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-009-0515-y