Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Extradural Pretemporal Transcavernous Approach

Purpose: Cavernous sinus (CS) surgery still represents a challenge for neurosurgeons due to its complex neurovascular anatomy. However, thanks to the knowledge of its microsurgical anatomy, the evolution of the microsurgical technique, and preclinical training, CS surgery has become safer, improving patient’s outcomes. The extradural pretemporal transcavernous approach (EPTA) allows excellent exposure of the upper third of the anterior part of the posterior cranial fossa (PCF). Therefore, the purpose of this abstract was to demonstrate a detailed cadaveric dissection of the the EPTA.

Methods: The surgical aspects of the EPTA were described on six embalmed and latex-injected cadaveric heads. A clinical case of a petroclival meningioma was used to illustrate the approach.

Results: The step-by-step approach from skin incision to the posterior fossa exposure was described using [Figs. 1] to [4]. Briefly, the approach started with a C-shape skin incision and temporalis interfascial dissection in order to protect the temporal branches of the facial nerve. A classic pterional craniotomy was performed and the dura of the middle cranial fossa carefully peeled using a Rhoton microdissector exposing GSPN, V1, V2, V3, and the lateral wall of the CS. An anterior clinoidectomty was performed improving the surgical corridor followed by the durotomy using microscissors to expose the CS and its contents as well as the anterior portion of the PCF.

Conclusion: Extensive training in the cadaver laboratory is essential to improve surgical techniques. The EPTA is recommended for pathologies and tumors located within or surround the CS region, and upper third of the anterior part of the posterior cranial fossa The most important structures to be taken into account in order to prevent iatrogenic lesions are cranial nerves II, III, IV and V, as well as the internal carotid and ophthalmic arteries.

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Artikel online veröffentlicht:
07. Februar 2025