25 Sagittal and Endoscopic Dissection of the Cranial Base
10.1055/b-0037-146650
25 Sagittal and Endoscopic Dissection of the Cranial Base
Maria Peris-Celda, Carlos Diogenes Pinheiro-Neto, and Rowan Valentine
Fig. 25.1. Specimen divided in the midsagittal plane, medial view of the left side.The cranial base, nose, and oral cavity are exposed. The medial wall of the orbit and maxillary sinus have been resected. The medial wall of the cavernous sinus has been removed to expose the internal carotid artery. Part of the clivus has been removed with a drill, leaving the cortical bone. Fig. 25.2. Specimen divided in the midsagittal plane, medial view of the left side.The auditory tube has been retracted posteriorly. Fig. 25.3. Specimen divided in the midsagittal plane, medial view of the left side.A segment of the cavernous part of the internal carotid artery has been resected to expose the nerves in the cavernous sinus. The pterygopalatine fossa has been opened and most of the pterygoid process removed. The auditory tube has been removed. Fig. 25.4. Specimen divided in the midsagittal plane, medial view of the left side.The tensor veli palatini muscle has been removed and the mandibular nerve exposed. Fig. 25.5. Medial view of the left cavernous sinus after removal of a segment of the cavernous part of the internal carotid artery.The petrous part of the internal carotid artery can be visualized. Fig. 25.6. Specimen divided in the midsagittal plane, medial view of the left side.The cervical part of the carotid artery has been retracted medially to expose the glossopharyngeal nerve. Fig. 25.7. Endoscopic endonasal view of the sphenoidal sinus.The sphenoidal sinus septation and the mucosa have been removed. Fig. 25.8. Endoscopic endonasal view of the sphenoidal sinus.The bone above and over the pituitary gland has been removed, and the outer layer of the dura mater divided and retracted laterally. The intercavernous sinus has been exposed.(*, dura mater, outer layer; **, inner layer) Fig. 25.9. Endoscopic endonasal view, anterior cranial base.The septum, ethmoidal sinus, and sphenoidal sinus have been completely resected. The dura mater has been removed to expose the pituitary gland, carotid arteries, and infero-medial aspect of the frontal lobes. The periorbita has been exposed bilaterally. Fig. 25.10. Endoscopic endonasal view of the pons.The septum, ethmoidal sinus, and sphenoidal sinus have been completely resected. The upper and middle portions of the clivus have been removed with a drill, and the dura mater has been removed. Fig. 25.11. Endoscopic endonasal view of the brainstem after removal of the clivus and dura mater.The anterior arch of the atlas has been partially removed, leaving a thin rim of bone, and the dens has been removed. Fig. 25.12. Endoscopic endonasal view of the spinal cord after removal of the anterior arch of the atlas and the dens.
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