The antero-medial triangle: the risk for cranial nerves ischemia at the cavernous sinus lateral wall. Anatomic cadaveric study.
OBJECTIVE
Vascular damage in the cavernous sinus can cause ischemic injury to the cranial nerves. An appropriate anatomical knowledge of the blood supply to the cranial nerves can help to reduce the morbidity associated with cavernous sinus surgery.


METHODS
Three formalin-fixed and six adult cadaveric fresh heads, with common carotid arteries injected, were used for anatomical dissection in this study. A fronto-temporal craniotomy was performed and the cavernous sinus was explored according to the Dolenc technique. With microsurgical dissection and photographic documentation, we demonstrate the anatomy of the superior orbital fissure artery in the antero-medial triangle.


RESULTS
The 12 explored cavernous sinuses demonstrated the presence of two principal branches directly from the intracavernous internal carotid artery that supply the cranial nerves: the infero-lateral trunk and the meningohypophyseal trunk. The artery of the Superior Orbital Fissure (SOF), originated more often from the infero-lateral trunk, and vascularized the III, IV, VI, and VI, and ophtalmic division of the trigeminal nerve (TGN VI) at their entry in the fissure.


CONCLUSIONS
In this study we demonstrate that the superior orbital fissure artery is a branch from the infero-lateral trunk which runs immediately under the reticularis layer at the level of the anteromedial triangle in the lateral wall of the cavernous sinus. The blood supply to all cranial nerves in the SOF is at risk to injury when the lateral wall of the cavernous sinus is transgressed at the anteromedial triangle since the SOF-artery runs superficially at this level.
Section of Neurological Surgery of Bolzano, Italy. micheleconti@hotmail.com
M
M
Conti
D M
DM
Prevedello
R
R
Madhok
A
A
Faure
U M
UM
Ricci
A
A
Schwarz
R
R
Robert
A B
AB
Kassam
D002102:Cadaver; D002343:Carotid Artery, Internal / Q000473:pathology / Q000601:surgery*; D002426:Cavernous Sinus / Q000294:innervation / Q000473:pathology / Q000601:surgery*; D003391:Cranial Nerves / Q000098:blood supply* / Q000473:pathology; D003399:Craniotomy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000473:pathology*; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods; D012307:Risk Factors