By D. Parkinson (auth.), Vinko V. Dolenc M.D. (eds.)

The administration of vascular and tumorous lesions of the parasellar quarter nonetheless continues to be the most difficult initiatives in neurosurgery. it's only a short while in the past that the main ideas of the anatomy of the so-called cavernous sinus have been defined intimately. Surgical interventions during this quarter are very complicated, they're time-consuming and require an in depth again­ floor of expertise in surgical procedure of the cranial base. Pioneer anatomical reports of the parasellar sector performed through Taptas, and the bold direct operative strategy brought by way of Parkinson professional­ moted the improvement of contemporary neuroradiological intervention proce­ dures, which have been initiated by means of Serbinenko and additional subtle by way of Debrun, Vifiuela and others. The means of the removable balloon catheter prompted surgeons to continue with the direct operative method of lesions of the parasellar area. at the present time, it really is difficult to visualize a winning guy­ agement of vascular pathologies of this area with no complementary use of the 2 techniques.

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This feature makes it difficult to dissect the Gasserian ganglion. It is necessary to uncover the plexii and separate them carefully from the vertical meningeal tracts, which must be cut as a last step. Figure 8 represents a case of intracavernous carotidealloop. The lateral wall was resectioned in its posterior two thirds of the region, from a pregasserian plane. The resection continues horizontally along the ophthalmic branch up to the anterior third of the region perpendicularly with respect to the anterior clinoid process.

As it does, not have intradural elements the two layers face and touch each other. The sellar meningeal lining between the gland and the osseous floor is clearly defined. This layer is a continuation of the dura mater from the base where it unfolds at its insertion into the dorsum sellae. The internal layer lines the sella floor, while the external layer jumps from the dorsum of sella up to optic canal, forming the so-called diaphragm of sella. The latter is 50 H. A. Conesa et al. Fig. 5. Midhypophyseal coronal section shows the anterior loop of ICA.

It is a specimen with scarce sphenoidal pneumatization and with a pituitary gland which might correspond to the anatomical basis of an empty sella. Figure 5 complements Fig. 4. It is observed from the back: the constitution of the foramen ovale and the free border of the tentorium crossing above the petrous portion to form the external wall of the Gross anatomy of the cavernous region 49 Fig. 4. Detail of cavernous area of Fig. 3. Anterior loop of rCA (AL), frontal lobe (FL), Sylvian fissure (SF), anterior clinoid ligament (ACL), ophthalmic vein (0 V), temporal lobe (TL), medial limit of the cavernous region (ML), Gasserian ganglion (GG), internal carotid artery (/CA) , cranial nerves (II, III, IV, VII, VI) cavernous region.

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