title: Operative surgical nuances of modified extradural temporopolar approach with mini-peeling of dura propria based on cadaveric anatomical study of lateral cavernous structures.
abstract: BACKGROUND
  Extradural temporopolar approach (ETA) has been modified as less invasive manner and named as trans-superior orbital fissure (SOF) approach with mini-peeling technique. The present study discusses the operative nuances of this modified technique on the basis of cadaveric study of lateral cavernous structures.
  
  
  METHODS
  In five consecutive cadaveric specimens, we performed an extradural anterior clinoidectomy with mini-peeling of the dura propria to expose the anterior clinoid process entirely. We also investigated the histological characteristics of the lateral cavernous sinus (CS) between the dura propria and periosteal dura at the SOF, foramen rotundum (FR), and foramen ovale (FO) levels, and of each trigeminal nerve division.
  
  
  RESULTS
  Coronal histological examination of the lateral wall of the CS showed invagination of the dura propria and periosteal dura into the SOF. In contrast, no such invagination was observed at the levels of the FR and FO. This finding supports the technical rationale of the only skeletonization of the SOF for peeling of the dura propria but not FR. In addition, our modified ETA method needs only minimal dural incision between the SOF and FR where no cranial nerves are present.
  
  
  CONCLUSIONS
  Our technical modification of ETA may be recommended for surgical treatment of paraclinoid lesions to reduce the risk of intraoperative neurovascular injury.
authors: Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors: Naoki
authors: N
authors: Otani
authors: Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors: Kojiro
authors: K
authors: Wada
authors: Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors: Terushige
authors: T
authors: Toyooka
authors: Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors: Kazuya
authors: K
authors: Fujii
authors: Department of Anatomy and Neurobiology, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors: Yasushi
authors: Y
authors: Kobayashi
authors: Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors: Kentaro
authors: K
authors: Mori
keywords: Anterior clinoidectomy; cavernous sinus; extradural temporopolar approach; paraclinoid lesion; skull base surgery