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Microsurgical and histological identification and definition of an interdural incision zone in the dorsolateral cavernous sinus

  • Experimental Research - Neurosurgical Anatomy
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Abstract

Objectives

The anatomy of the cavernous sinus is described controversially in a number of publications. In the present cadaveric study, the architecture of the dorsolateral wall of the cavernous sinus is studied microsurgically and histologically.

Materials and methods

Twenty cadaveric skulls have been dissected through a classical surgical frontotemporal approach. The temporal skull base was flattened and anatomical landmarks like the meningo-orbital band, superior orbital fissure, foramina rotundum, ovale, and spinosum were identified. Lateral of the trigeminal foramina, the dura was cut and the periosteal dural layer was separated from the meningeal layer, identifying an interdural zone. The length and the extent of this zone were evaluated. The dural architecture of the interdural incision zone was examined histologically.

Results

In all specimens, two dural layers lateral of the trigeminal foramina could be separated. The identified interdural incision zone extended in a length of 3.8–6.4 cm in the antero-posterior direction. The zone could be followed medially to the superior orbital fissure for 5.3 mm and lateral of the foramen spinosum for 6.4 mm. The separation of the dural layers allowed the approach to the superior border of the cavernous sinus through this interdural incision zone. The histological analysis of the interdural incision zone showed clearly the existence of two dural layers.

Conclusions

The architecture of the temporal-fossa-dura allows the microsurgical separation of two meningeal dural layers through a length of 5–6 cm next to the trigeminal foramina. Opening this interdural incision zone allowed exploring the superior border of the cavernous sinus.

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Acknowledgments

The cadavers were dissected at the laboratories of the Anspach Company in Palm Beach, Miami, USA.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent licensing arrangements) participation in speakers bureaus; or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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    Authors and Affiliations

    1. Department of Neurosurgery, University Hospital Bochum, Knappschaftskrankenhaus Bochum Langendreer, Bochum, Germany

      Peter Spangenberg & Albrecht Harders

    2. Department of Neurosurgery, Wedau Kliniken Dusiburg, Zu den Rehwiesen 9, 47055, Duisburg, Germany

      Adrian Kinzel, Schreiber Lutz, Sebastian Lücke, Martin Scholz & Athanasios K. Petridis

    3. Department of Neurosurgery, Sana Kliniken, Zu den Rehwiesen 9, 45077, Duisburg, Germany

      Adrian Kinzel

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    1. Adrian Kinzel
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    Comment

    The authors have to be congratulated for studying the history of cavernous sinus (CS) as far back as to the 16th century. This for sure repeatedly puts light on the complete picture of the cavernous sinus. However, the reader of the their report is very surprised that they did not mention JN Taptas, who conducted important anatomy studies on this region during the Second World War [4–7]. One is surprised that they started separating the dural layers far posteriorly to the CS, since it is well known that the V3 is not in the CS, and it holds even more for the point of their first incision even more posteriorly, posteriorly to the foramen spinosum. Personally, I am surprised about their statement that only in 5 % of cases could the interdural zone be opened by a primary dural incision close to the ophthalmic nerve. In my personal experience, in all of the cases I have operated (over 3000), it was always possible to open the interdural space from the anterior side [1, 2]. The authors could also profit from the evolution of the approach to the CS [3]. The measurements of the length of the individual branches of V1, V2, and V3 as well as the diameter of the GG are welcome from the anatomical point of view for educational purposes for students, but for practical (surgical) reasons, are not so “vitally” important. For most intracavernous pathologies, the dura underlying the temporal lobe should be dissected from the lateral wall of the CS in its complete extent from the CN III to the V3 including the GG, and it goes without saying that in practical surgery, the cavernous sinus should be kept close as long as possible during the procedure. It is well known that for all the meningiomas as well as for some other tumors in the region, the sphenoid wing and the anterior clinoid process (ACP) should be removed prior to dissection the dura of the under aspect of the temporal lobe from the lateral side of the cavernous sinus. Except in some cases of trigeminal neurinomas in the region might tumors be removed without resection of the sphenoid wing and the ACP.

    In the case that the authors review the available literature, they may change their statement that “The anatomy of the CS is described controversially in a number of publications.” The anatomy of the CS has been studied by many authors and the practical value of the known anatomy of the region has been practiced in thousands of operations—in the central skull base—around the globe.

    V. Dolenc

    Ljubljana, Slovenia

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    Adrian Kinzel and Peter Spangenberg contributed equally to this work.

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    Kinzel, A., Spangenberg, P., Lutz, S. et al. Microsurgical and histological identification and definition of an interdural incision zone in the dorsolateral cavernous sinus. Acta Neurochir 157, 1359–1367 (2015). https://doi.org/10.1007/s00701-015-2467-8

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