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the microscopic cavernous sinus surgery via the extended transsphenoidal approach an anatomic study of cranial nerve and internal carotid Artery in cavernous sinus

Aim:The microscopic surgical anatomy of the cavernous sinus via the extended transsphenoidal approach was studied to establish an anatomic basis for surgical treatment to remove the tumor in the lateral area of internal carotid atery.Methods:Simulated surgery was performed on seven adult cadaver heads via extended transsphenoidal approach.The appearance feature of the cavernous segment of the ICA and its branch vessels and its relationship with cranial nerve were observed under microscope.Some anatomic parameters were measured.Results:The cavernous segments of the ICA have two important branches.The Inferior Artery of cavernous sinus arises from the lateral wall of the medial part in horizontal segment of internal carotid Artery.The Inferior Hypophysial Artery arises from the meningeal hypophyseal stem which comes from ICA.The abducent nerve in the lateral region of ICA goes into the superior orbital fissure.The average distances from the lateral edge of he cavernous segment of the ICA to the oculomotor nerve,trochlear nerve,abducent nerve and optic nerve that go into superior orbital fissure were 3.4 mm,3.4 mm,3.9 mm and 4.5 mm respectively.Conclusion:The complexity of the structure of the nerves and blood vessels in the cavernous sinus region,familiarity with the anatomic relationships in the region may help to protect the Inferior Artery of cavernous sinus and abducent nerve in cavernous sinus in the surgery via the extended transsphenoidal approach and reduce surgical complications.