MICROANATOMÍA QUIRÚRGICA DEL SENO CAVERNOSO: SEGUNDA PARTE - UN NUEVO REPARO PARA ACCEDER AL CONTENIDO DEL SENO
Palabras clave:
Anatomía microquirúrgica, Seno cavernoso, Microcirugía, Arteria carótida, Pares craneanos, Triángulos, Microsurgical anatomy, Cavernous sinus, Microsurgery, Carotid artery. Cranial nerves, TrianglesResumen
ResumenObjetivo: Hallar reparos anatómicos que permitan el abordaje seguro al seno cavernoso, utilizando medidas cronométricas para la conservación de estructuras vasculonerviosas.
Métodos: Se disecaron 25 especímenes frescos obtenidos del Instituto de Medicina Legal y ciencias forenses a través de un abordaje extradural y la medición con microcalibrador L& W tools desde la apófisis clinoide anterior y posterior hasta las estructuras neurovasculares de importancia. Se presentan los resultados de las mediciones y se hace un análisis de sus resultados donde se especifica la longitud de cada una de las aristas de los triángulos de dicha región.
Resultados: Se encuentra que a 5 milímetros de la punta del apófisis clinoide anterior medidos hacia abajo en una línea imaginaria perpendicular al piso de la fosa media en 21 especímenes se accedió al área del triangulo de Parkinson es decir entre el IV par y el oftálmico de Willis, pudiendo fácilmente encontrar el tronco meningohipofisiario, la porción transversa de la carótida interna intracavernosa y el segmento cavernoso del motor ocular externo; solo en cuatro piezas se llego al triangulo superior (cuya área es menor que la del triangulo de Parkinson) y a través de este no fue fácil evidenciar ni el tronco meningohipofisiario ni el sexto par.
Conclusiones: Debido al mayor área del triángulo de Parkinson (dada por su arista posterior más larga) el abordaje a dicho triángulo podría ser una vía útil para la búsqueda de patologías asociadas con las estructuras neurovasculares que a través de dicho triangulo se pueden visualizar (aneurismas del tronco meningohipofisiario, aneurismas saculares del segmento transverso de la carótida interna intracavernosa y/o neurinomas del VI par intracavernoso); y se en cuentra a 5 milímetros desde la punta de la apófisis clinoide anterior medidos hacia abajo en una línea imaginaria perpendicular al piso de la fosa media y el borde inferior de dicho triángulo.
Palabras clave: Anatomía microquirúrgica, Seno cavernoso, Microcirugía, Arteria carótida, Pares craneanos, Triángulos.
CAVERNOUS SINUS SURGICAL MICROANATOMY, SECOND PART A NEW LANDMARK TO APPROACH SINUS CONTENT
AbstractObjective: To find anatomical landmarks that allow a safe approach to the cavernous sinus, using craniometrical measurements to preserve neurovascular structures, to know how to reach them from the middle fossa, and provide surgical microanatomic direction into and around of the cavernous sinus.
Methods: 25 fresh specimens obtained from de Forensic Institute (Bogotá) were dissected, using an extradural approach, and measuring with an L&W tools microcalliper the distance from the anterior and posterior clinoid processes to the important neurovascular structures. The results of the measurements are shown, as well as the analysis of the results, specifying the length of each edge of every triangle in that region.
Results: We found a constant of a 5 millimeter distance from the tip of the anterior clinoid, on an imaginary line going down perpendicular to the floor of the medial fossa, in 21 specimens the area of the parkinson´s triangle was reached, between the IV cranial nerve and the Willis ophthalmic nerve, easily finding the meningohypophyseal stem, the trasverse portion of the intracavernous internal carotid artery and the cavernous segment of the external ocular motor nerve. In only four specimens the superior triangle was reached (with a smaller area than the Parkinson’s triangle), and through this approach it was not easy to identify the meningohypophyseal stem and the IV cranial nerve.
Conclusions: Due to the greater area of the Parkinson’s triangle (given by a longer posterior edge), the approach through this triangle could be a useful path to find pathologies associated with neurovascular structures that can be visualized through the triangle (aneurysms of the meningohypophyseal stem, saccular aneurysms of the intracavernous VI cranial nerve); and it is found 5 mm away from the tip of the anterior clinoid measuring down on an imaginary line, perpendicular to the floor of the medial fossa and the superior edge of the triangle.
Key words: Microsurgical anatomy, Cavernous sinus, Microsurgery, Carotid artery. Cranial nerves, Triangles.
Biografía del autor/a
Juan Armando Mejía C., MD. Fundación Santa fe.
Maximiliano Páez Nova, Clínica Corbis Envigado, Antioquia
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