Accessing the Lateral Compartment of the Cavernous Sinus via the Endoscopic Endonasal Corridor: Technical Note AND Institutional Clinical Experience

Introduction: The modules of the extended endoscopic endonasal approach (EEA) have revitalized the surgical treatment of pathologies within the cavernous sinus. Nevertheless, the lateral compartment continues to present significant challenges in managing lesions located there. In this study, we delineate a step-by-step guide to the surgical technique utilizing EEA for approaching the lateral cavernous sinus compartment, along with our related clinical experiences.

Methods: The surgical procedure entails a wide sphenoidotomy and an ipsilateral transpterygoid approach. The bone overlying the carotid is removed as well as the bone overlying the superior orbital fissure, Meckel’s cave, and the pituitary gland. After obtaining hemostasis, the dural opening extends all the way from the foramen lacerum inferiorly to the proximal dural ring superiorly. The dissection continues aiming to identify the abducens nerve and separate it from the horizontal cavernous carotid artery. The inferolateral trunk is coagulated and divided to untether the carotid and allow its medial mobilization ([Fig. 1]). In order to comprehensively describe the abovementioned technique and its clinical applications, six cadaveric dissections were performed and our relevant institutional experience over the past-decade was reviewed.

Fig. 1 Anatomical dissection photographs showing the final steps when accessing the lateral cavernous sinus compartment endonasally, including division of the inferolateral trunk and internal carotid artery mobilization.

Results: An approach to the lateral compartment was undertaken in 18 patients, including 11 pituitary adenomas, 3 chondrosarcomas, 2 chordomas, and 2 meningiomas. Postoperative abducens nerve and trigeminal nerve paresis occurred in 4 and 1 patients, respectively. Vascular injury involving the internal carotid artery occurred in 2 patients without permanent sequelae early in the series, but evolution of the technique has significantly reduced the complication rate in the later years without any vascular injury being noted.

Conclusion: While accessing the lateral cavernous sinus compartment endonasally continues to be challenging, improvements in surgical techniques have increased both safety and effectiveness. Nonetheless, appropriate case selection and intra-operative decision-making remain essential.

Die Autoren geben an, dass kein Interessenkonflikt besteht.

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Artikel online veröffentlicht:
07. Februar 2025