Transcranial Microsurgical and Endoscopic Endonasal Cavernous Sinus (CS) Anatomy: A Cadaveric Study

Aims and Objectives Even in the era of tremendous microneurosurgical and endoscopic development, the cavernous sinus (CS) is a challenging anatomical site for a neurosurgeon. Many transcranial and a few endoscopic cadaveric studies have been done to study the CS; probably none were undertaken to study its microsurgical and endoscopic anatomy side by side. In this cadaveric study we perform a side-by-side comparison of the microsurgical and endoscopic anatomy of the CS that can help neurosurgeons deal with CS lesions more efficiently. Materials and Method Sixteen fresh cadaveric heads were studied after dissection. Six heads were dissected for transcranial study and six for endoscopic study of CS. During the transcranial study, the supratentorial brain was removed in three heads and CS and related anatomical structures were dissected. In the remaining heads, the CS was studied by keeping the brains in situ. In four heads both transcranial and endoscopic study was done simultaneously. Following dissection, microsurgical and endoscopic anatomy of CS was studied. Result The CS and related anatomical structures were dissected sequentially in all cases (transcranially in 10 [6 + 4] heads; endoscopically in 10 [6 + 4] heads), and their relationship was studied. Conclusion Microscopic and endoscopic exposure of the CS is relatively easy in cadavers. But endoscopic or microsurgical exposure of the CS during surgery is more difficult requiring skill. With experience of the cadaveric study, the CS may be explored via transcranial microsurgery, endonasal endoscopy, or both simultaneously, according to the nature and extension of the pathology.