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Schematic drawing of the internal carotid artery triangle. MB, medial border; LB, lateral border; DB, dorsal border.
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The anatomical and surgical approach to the sella region is of special interest for microsurgeons involved in ear, nose, and throat surgery, neurosurgery, ophthalmology, maxillofacial surgery, and skull base surgery. We investigated the surface morphology of the cavernous sinus and the sella turcica in 48 adult and 2 neonate specimens. To simplify...
Context in source publication
Context 1
... of the distances are given in conditions is absolutely necessary because of the limita- 186 Table 1. tions of the view field, especially in neuroendoscopy.' Preinfundibular triangle (see Fig. 2) Right border 12.3 8-15 Left border 12.6 9-15 Anterior border 13.8 8-18 2. Parasellar triangle (see Fig. 3 Internal carotid artery triangle (see Fig. 4 Essential landmarks in the parasellar region are the ACLPs and PCLPs, tuberculum and dorsum sellae, pitu- itary stalk, and dural entrance points of cranial nerves III, IV, V, and VI. This normal surface morphology can be altered by, for example, aneurysms, tumors, or in- flammations. 18,19 The classic anatomical descriptions2-4 give an ...
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Citations
... In the reported 17 cases, the dehiscence of sella diaphragm was seen in 15 cases and the string-like bonds at the stalk of pituitary gland was seen in 2 cases. [36] The greater superficial petrosal nerve is the best landmark for finding the position of the carotid canal in the petrous bone. The canal runs parallel below the nerve. ...
The oculomotor triangle is denoted as the "Triangle of Hakuba" or the "Hakuba's Triangle." This oculomotor triangle is a significant anatomical landmark. Oculomotor nerve, abducens nerve and part of the internal carotid artery (ICA) lie in this triangle. The determination of this analysis is to calculate the oculomotor triangle in dry processed skull bones of the south Indian population and its clinical significance. Fifty-one processed skulls of human origin were received from Anatomy Department, Basic Medical Sciences, Saveetha Dental College. Length from anterior-clinoid process (ACP) to posterior-clinoid process (PCP), length from PCP to APEX, and length from ACP to APEX were measured. Paired samples t-test was considered to analyze the values between the right triangle with the left triangle. From the measurements taken, the mean for the left side of the oculomotor triangle, ACP to PCP was 8.0591 ± 0.52 mm and the right side was 7.5482 ± 0.52 mm. The mean left side of the oculomotor triangle, measured from PCP to APEX was 6.73 ± 0.48 mm and the right side was 6.55 ± 0.72 mm. The mean of the left side of the oculomotor triangle, measured from ACP to APEX was 15.94 ± 0.682 mm and the right side was 16.21 ± 0.747 mm. Through this paired triangle of the cranial cavity, the horizontal section of ICA may be correlated with numerous vascular-related pathological considerations.
... Prescher, et al. used reproducible and reliable landmarks in the Sella region to define three triangles on 48 adult skull base specimens [34]. ...
... The anterior border is formed by the line connecting the medial points of each optic nerve before entering the optic canal. The average lengths of these borders in mm are 12.3, 12.6 and 13.8 for the right, left and anterior borders, respectively [34]. ...
... On average, the length of the medial, lateral and ventral borders on the left of the sella were 12.1, 12.5, and 8.3 mm, respectively. On the right side, the corresponding measurements were 12.4, 12.5, and 8.3 mm in the same order [34]. ...
There are multiple anatomical triangles of the skull base. However, to our knowledge, there has been no comprehensive review of these geometric landmarks. To allow for a safe and consistent approach to lesions of the skull base such as those near the internal carotid artery, internal acoustic meatus, and cavernous sinus, a comprehensive review of the variations with illustrations is required. This article provides an overview of the anatomical borders, dimensions, and surgical implications as well as illustrations of the major skull base triangles.
... We believe that the tumour we operated on was a trigeminal schwannoma (Figure 7), even though the first symptom was a deficit of the 6th CN. The scans, in fact, show that the tumour was growing in the space between the dura mater and the inner membrane of the cavernous sinus lateral wall where the branches of the trigeminal nerve run, while the 6th CN runs inside the venous sinus [11][12][13]. In the literature there are other cases of neurinoma of the 5th CN with a clinical onset of palsy in the 6th CN [14]. ...
We report a rare case of schwannoma of the lateral wall of the cavernous sinus, an exceedingly rare lesion affecting this anatomical district, and discuss salient aspects of the surgical approach to the cavernous sinus, which are traditionally considered technically challenging due to the high risk of postoperative morbidity and mortality related to the presence of the cranial nerves and internal carotid artery.
... Microsurgical anatomy of the cavernous sinus has been described using triangles outlining natural corridors through which pathological lesions can be reached. 14,15 The acousticofacial-glossopharyngeal triangle (AGT) may be used in conjunction with other anatomic landmarks to allow for more accurate localization of the middle and lower neurovascular complexes in the posterior cranial fossa. Rapid identification and preservation of important anatomic landmarks is essential to performing procedures safely within the CPA. ...
The cerebellopontine angle (CPA) poses a surgical challenge due to the complexity and variation of its associated structures. This study examined the relationship between the glossopharyngeal nerve (CN IX) and the acousticofacial complex (AFC). Retrosigmoid suboccipital dissections were preformed on 10 cadaveric specimens. A triangle formed by the AFC, CN IX, and the skull base was consistently observed. The cisternal portions of the AFC and CN IX formed two sides of the triangle. The base was formed by a line traversing the respective dural portals of these nerves at the skull base. Triangular proportions were utilized to predict distances from five points along the course of CN IX to a corresponding point along the course of the AFC. Predicted distances were not statistically different when compared with cadaveric measurements in all 10 specimens (p > 0.05). A table of predicted distances between CN IX and the AFC at all five points along CN IX was developed, revealing a quantitative model to predict the native location of the AFC in the lateral pontine cistern. The triangle and predicted location of the AFC can serve as points of reference for the identification and preservation of these structures in CPA surgery.
Procedures performed along the skull base require technical prowess and a thorough knowledge of cranial anatomy to navigate the operative field. Anatomical triangles created by unique anatomical structures serve as landmarks to guide the surgeon during meticulous skull base procedures. The corridors rapidly orient the surgeon to the operative field and permit greater confidence regarding skull base position during dissection. A literature review was performed with use of the PubMed database and reference list searches from full-text reviewed articles, which resulted in the identification of 31 distinct anatomical triangles of the skull base. The 31 anatomical triangles are categorized into a corresponding cranial fossa or the extracranial subsection. The triangles described in the manuscript include junctional, interoptic, precommunicating, opticocarotid, supracarotid, parasellar, clinoidal, oculomotor, carotid-oculomotor, supratrochlear, infratrochlear, anteromedial, quadrangular, anterolateral, posteromedial, posterolateral, lateral, superior petrosal, oculomotor-tentorial, inferomedial, inferolateral, glossopharyngo-cochlear, vagoaccessory, suprahypoglossal, hypoglossal-hypoglossal, infrahypoglossal, parapetrosal, suprameatal, retromeatal, suboccipital, and the inferior suboccipital. The goal of this review is to create a comprehensive resource for existing skull base triangles that includes borders, contents, surgical applications, and illustrations to enhance awareness and inform microsurgical dissection.
