By Vinko V. Dolenc M.D., Ph.D. (auth.)
The determination of Harvey Cushing to go away basic surgical procedure and focus on the child box of imperative apprehensive approach surgical procedure used to be on reflection a landmark within the historical past of neurosurgery. His targeted paintings, and likewise that of his colleague Walter Dandy, originated with the wishes of either pioneers to appreciate surgical anatomy and neurophysiology. the basic wisdom and surgical techni ques that they supplied turned the normal of excellence for a number of generations of neurosurgeons; loads in order that the final trust used to be that the surgical options couldn't be more suitable upon. Twenty-five to thirty years in the past microtechniques started to appear in a number of surgical study facilities, they have been then steadily utilized to scientific neurosurgery and feature contributed to a brand new point of knowing in surgical anatomy and neurophysiology. we're now lucky to have a brand new common of morbidity and mortality within the surgery of intrathecal aneurysms, angiomas, and tumors. it's been acknowledged that microneurosurgery was once attaining its limits, specially whilst treating lesions in and round the cavernous sinus and cranium base; these lesions infamous for involvement of the dural and extradural cubicles, with a bent to infiltrate adjoining nerves and blood vessels. the risks of uncontrollable hemorrhage from the basal sinuses and post-operative CSF rhinorrhea seemed unsurmountable. The lateral points of the petro-clival quarter were of curiosity to some pioneering ENT surgeons and neurosurgeons however the cavernous sinus in so much respects has remained the ultimate unconquered summit.
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Additional resources for Anatomy and Surgery of the Cavernous Sinus
10. The anterior part of the paramedial triangle is shown under higher magnification. Its most important feature is that the IVth nerve and VI run over the IIIrd nerve before they enter the SOF. Deep in the center of this corner, the VIth nerve is seen embedded in "venous blood" Oculomotor trigone The triangular area of the oculomotor trigone, described previously , is located between the folds of the dura running between the ACP and the PCP, and medially with the fold of the dura running from the PCP to the ACP.
Since, in this preparation, the IVth nerve and VI have been separated, only the anterior segment of the former nerve is attached to the latter one. Through the triangle "venous blood" is seen to run posteriorly over the Vth nerve into the SPS the CS. It should be noted that the region of the incomplete, and often absent, inner reticular layer between the IIIrd nerve and VI, described by Umansky and Nathan, corresponds to the region of the dura of the CS over the paramedial and Parkinson's triangles .
For better visualization of the VIth nerve, the leA and the sympathetic fibers running from the leA to the VIth nerve and hence to VI, it is necessary to retract VI medially. The fibrous covering of the bone is the direct continuation of the dura which runs from the apex of the petrous bone, forms the lateral ring around the leA medial to the foramen lacerum, and proceeds further anteriorly to cover the bone. The fatty tissue at the anteromedial corner of the anterolateral triangle is most probably a continuation of the fatty tissue from the orbit.