Operative surgical nuances of modified extradural temporopolar approach with mini-peeling of dura propria based on cadaveric anatomical study of lateral cavernous structures

摘要

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. Conclusion: Our technical modification of ETA may be recommended for surgical treatment of paraclinoid lesions to reduce the risk of intraoperative neurovascular injury.