Extradural approach to the lateral sellar compartment

ABSTRACT

This paper describes an extradural approach to the lateral sellar compartment (LSC, cavernous sinus), which represents a refinement of the original work performed on this topic by Parkinson, Dolenc, and Hakuba, and other enthusiastic neurosurgeons. This detailed description of the extradural approach is based on the dissection of 30 cadaver specimens and surgical experience of 110 LSC lesions. The extradural approach is based on the developmental anatomy of the LSC, and provides (1) complete exposure of the entire LSC; (2) excellent control of the intracavernous carotid artery; (3) easier identification and less injury of the cranial nerves; (4) reduced brain damage with limited extradural retraction; (5) preserving the Sylvian vein and the sphenoparietal sinus; (6) minimal intradural blood spillage; (7) shorter operative time; (8) physiological reconstruction of the lateral wall to prevent CSF leakage; and (9) access to the contralateral LSC. As the LSC is an extradural space, the extradural approach may be safely employed to access lesions involving the LSC.