해면정맥동내 속목동맥과 정맥구조에 대한 미세해부학적 연구

윤도흠,이규창,최중언,서재관 대한신경외과학회 1991 Journal of Korean neurosurgical society Vol.20 No.5

The description of the carotid artery and venous structure in the cavernous sinus, because of their size and location, was very short of even absent in the most anatomical textbooks. But, since the report of a direct surgical approach to the cavernous sinus by Parkinson in 1965, there has been an increasing number of reports of successful direct surgical approaches to the cavernous sinus. With the introduction of microsurgery and the developement of new techinques and surgical approach, a more accurate knowledge of vascular anatomy of the cavernous sinus is not only of theoretical academic interest, but may also have implications. To better study this vascular anatomy, eighty cavernous sinuses from fresh cadavers of adult subjects were dissected under the operating surgical microscope. A red solution of resin was injected to facilitate the dissection, and twenty cavernous sinuses were studied, based on serial sections in the coronal planes for the study of the venous structure of the cavernous sinus. The results of this study were summarized as follows. 1) The most common branch of internal carotid artery in the cavernous sinus was the meningohypophyseal trunk, the largest intracavernous branch, which was presented in 100% of our specimens, the inferior cavernous artery, in 96.3%, and capsular artery, in 13.8%. 2) The ophthalmic artery arised within the paraclinoid portion of the internal crotid artery in 33.8%. In 3.8%, it entered the floor of the optic canal through a foramen in the bone. But there was no intracavernous origin of the ophthalmic artery. 3) The cavernous sinus seemed to be a venous pathway, an irregular network of venous channel, not a trabeculated sinus.

해면정맥동의 해부학적 관찰

전우진,이기찬,주정화 대한신경외과학회 1984 Journal of Korean neurosurgical society Vol.13 No.4

Fifty four preparations of the cavernous sinus from twenty seven cadavers were studied in detail under microscopic magnification, with special attention to nerves and arteries related to the wall of the sinus. Significant findings were: 1) Three types of relationship between the nerves and arteries in relation to the wall of the sinus were found. Type Ⅰ: The nerves Ⅲ, Ⅳ and Ⅴ-Ⅰ were embedded in the lateral wall) and the internal carotid artery (I. C. A.) and nerve Ⅳ passed through the cavity of the sinus (26 specimens, 48 %), Type Ⅱ: The cavity of the sinus was divided into two compartments by a septum close to the lateral wall, with nerves Ⅳ and Ⅴ-Ⅰ located within the septum (18 specimens, 33%), Type Ⅲ: Anatomy was similar to the type Ⅰ, except that the I.C.A. was included in the medial or lateral wall (10 specimens, 19%). 2) Arterial variations branching from the intracavernous portion of the I.C.A. were classified into four types. Type Ⅰ: Meningohypophyseal trunk arising from I.C.A. (28 specimens). Type Ⅱ: Dorsal meningeal artery from I.C.A. (10 specimens). Type Ⅲ: Tentorial artery from I.C.A. (4 specimens). Type Ⅳ: Meningohypophyseal trunk from I.C.A. in addition, the artery of inferior cavernous sinus (12 specimens). 3) The main three branches of the intracavernous portion of the I.C.A. were the meningohypophyseal artery, which was presented presented in 100% of our specimens, the artery of inferior cavernous sinus (78%), and McConnell's capsular artery (43 %). Intracavernous origin of the ophthalmic artery were observed in four specimens (8%). 4) The surgical triangle spaces were found to be present in all our specimens, which were formed by the superior margin of it with the lower margin of nerve IV and by the inferior margin with the upper margin of nerve Ⅴ-Ⅰ.

사체해부를 통한 해면정맥동의 외과적 접근방법에 대한 연구

김동호,이무섭,민경수 충북대학교 의과대학 충북대학교 의학연구소 1998 忠北醫大學術誌 Vol.8 No.1

연구목적 : 사체해부를 통해 해면정맥동의 중요 해부학적 지식을 습득 기술하고 해면정맥동의 병소를 수술시 효과적인 접근 방법을 알아 보고자 하였다. 재료 및 방법 : 경부에서 절단된 사체의 두부만을 취하여 총경동맥, 추골동맥. 내경정맥에 생리식염수로 충분히 관류하여 혈관내를 세정시키고 총경동맥에는 적색 라텍스, 내경정맥에는 청색 라텍스를 각각 주입하여 뇌 혈관계가 잘 구분이 되도록 처리하였고 Midas Rex 고속드릴, 수술 현미경 등으로 해면정맥동에 수술적 접근방법을 시행하여 수술현미경 사진촬영 및 비데오 녹화를 통해 반복적이고 세부적인 해면정맥동의 수술적 접근을 시도하였다. 결과 : Parkinson, Dolenc 등 선구적 연구자들의 업적을 바탕으로 하여 해면정맥동 병소의 치료시 이에대한 외과적 접근법을 포괄적으로 12 단계로 나타내었다. 이 접근법의 외과적 과정은 경막내와 경막외로 나누어 각각 6단계로 나누어 시행하였다. 각 단계의 골, 신경, 혈관 구조들의 연관관계를 이해 습득하였다. 결론 : 뇌기저부의 해면정맥동은 과거 수술적으로 함부로 접근할수 없는 성역으로 여겨 졌으나 최근 사체해부를 통해 해면정맥동의 해부학적 지식이 더욱 밝혀지고 있고 고속드릴 및 미세 수술기구의 발전 및 모니터링 시스템의 도입으로 해면정맥동의 병소제거 수술이 적극적으로 행해지고 있다. 사체 해부를 통해 이 영역의 중요 해부학적 지식을 습득하는 것은 실제 환자의 해면정맥동 수술의 경험에 꼭 필요하다. Purpose : The lesions of cavernous sinus have been considered surgically inaccessible to remove it. However. studying the cadaver dissection, effective surgical approaches to the cavernous sinus developed. The purpose of this study is to understand the precise anatomy and the procedure of surgical approach of the cavernous sinus. Materials & Methods : The head was obtained from human cadaver. The common carotid artery, internal jugular vein and vertebral artery were irrigated with saline bilaterally. Arteries were injected with red latex and veins were injected with blue latex to make good contrast on dissection. The whole procedure to dissect from surface to skull base using high speed drill was taken with still camera and video attached to Zeiss operating microscope to get the precise knowledge of microscopic anatomy of the cavernous sinus. Results : Based on the work of Parkinson, Dolenc, and other pioneering investigators, a comprehensive surgical approach to the cavernous sinus for the treatment of sinus lesions is presented in 12 simple steps. The procedures of this approach is divided into an extradural and intradural phase, each with 6 steps. The bony, neural, and/or vascular structures of each step are described. Conclusion : Using the microsurgical apparatus including high speed drill, the activity to remove the lesion of cavernous sinus is enhanced.

해면 정맥동 혈전증(Cavernous Sinus Thrombosis) 치험례

김경원,김용관,장명진,장현석 大韓顎顔面成形再建外科學會 1995 Maxillofacial Plastic Reconstructive Surgery Vol.17 No.4

Cavernous sinus thrombosis is one of the major complications of abscesses of the maxillofacial region. The initial symptoms of CST are usually pain in the eye and tenderness to pressure. this is associated with high fluctuating fever, chills, rapid pulse, and sweating. Venous obstruction subsequently causes edema of the eyelids, lacrimation, proptosis, chemosis and retinal hemorrhages. Blindness is sometimes an accompaniment of cavernous sinus thrombosis when the infection also involves the orbit. There is also cranial nerve involvement (oculomotor, troclear, abducence) and ophthalmoplegia, diminished or absent corneal reflex, ptosis, and dilation of the pupil occur. The terminal stages bring signs of advanced toxemia and meningitis. Infections of the face can cause a septic thrombosis of the cavernous sinus. Furunculosis and infected hair follicles in the nose are frequent causes. Extractions of maxillary anterior teeth in the presence of acute infection and especially curettage of the sockets under such circumstances can cause this condition. The infection is usually staphylococcal. The inflection may spread directly through the pterygoid plexus of veins and the pterygomaxillary space and then ascend into the sinus or it may spread directly from the pterygopalatine space to the orbit. This is possible because of the absence of valves in the angular, facial, and ophthalmic veins. The treatment is empirical antibiotic therapy followed by specific anbibiotic therapy based on blood or pus culture. The inflection usually involves one side, however, it may easily spread to the opposite side through the circulus sinus. Unless it is treated early, the prognosis is poor even in this doses. Occasionally the antibiotics will not adequately resolve the septic thrombus, and death ensues. the use of anticogulants to prevent venous thrombosis has been recommended, but the efficacy of such therapy has not been substantiated. Surgical access through eye enucleation has been suggested. We report a case which demonstrates cavernous sinus thrombosis by the infection after the functional neck dissection and the intraoral reconstruction with auriculomastoid fascio-cutaneous island flap.

중두개와저 종양에 대한 수술적 치료

김일섭,나형균,이경진,조경근,박성찬,박해관,조정기,강준기,최창락,Kim, Il Seub,Rha, Hyung Kyun,Lee, Kyung Jin,Cho, Kyung Keun,Park, Sung Chan,Park, Hae Kwan,Cho, Jeung Ki,Kang, Jun Ki,Choi, Chang Rhack 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.9

Objective : We analysed various surgical approaches and surgical results of 28 middle cranial base tumors for the purpose of selecting optimal surgical approach to the middle cranial base tumor. Methods : In this retrospective review, 28 patients, including 16 meningioma, 6 trigeminal neurinoma, 2 pituitary adenoma, 2 craniopharyngioma, 1 facial neurinoma, and 1 metastatic tumor, underwent surgical treatment using skull base technique. Of theses, 16 tumors were mainly confined to middle cranial fossae, 5 tumors with extension into both anterior and middle fossa, and 7 tumors with extension into both middle and posterior fossa. Tumors that confined to the middle cranial fossa or extended into the anterior cranial fossa were operated with modified pterional, orbitozygomatic or Dolen'c approach, and tumors that extended into the posterior cranial fossa were operated with anterior, posterior or combined transpetrosal approach. Completeness of tumor resection, surgical outcome, postoperative complication, and follow up result were studied. Results : Total tumor removal was achieved in 9 tumors of 10 tumors that did not extended to the cavernous sinus, and was achieved in 7 tumors of 8 tumors that extended to the lateral wall of the cavernous sinus. Of 10 tumors that extended to the venous channel of the cavernous sinus, only 2 were removed totally. Surgical outcome was excellent in 14 patients, good in 10, fair in 2 and poor in 2. There were no death in this series. Dumbell type tumor which extended into both middle and posterior fossae showed tendency of poor prognosis as compared with tumors that confined middle cranial fossa and extended into both anterior and middle cranial fossa. Postoperative dysfunctions were trieminal hypesthesia in 3, oculomotor nerve palsy in 2, abducens nerve palsy in 2, hemiparesis in 2, cerebellar sign in 1, facial palsy in 1 and hearing impairment in 1. Conclusion : Based on our findings and a review of the literature, we conclude that, when selecting the surgical approach to the middle cranial fossa tumors, the most important factors to be considered were exact location of the tumor mass and existence of the cavernous sinus invasion by tumor mass. We recommend modified pterional or orbitozygomatic approach in cases with tumors located anterior and middle cranial base, without cavernous sinus invasion. In cases with tumors invading into cavernous sinus, we recommend Dolen'c or orbitozygomatic approach. And in lateral wall mass and the cavernous sinus, it is preferred to approach the tumor extradurally. For the tumor involing with middle fossa and posterior fossa(dumbell type) a combined petrosal approach is necessary. In cases with cavernous sinus invasion and internal carotid artery encasement, we recommend subtotal resection of the tumor and radiation therapy to prevent permanent postoperative sequele.

Persistent fetal superficial middle cerebral vein: an anatomical study

Suhani Sumalatha,Sushma R. Kotian,Ashwija Shetty 대한해부학회 2019 Anatomy & Cell Biology Vol.52 No.3

The superficial middle cerebral vein (SMCV) drains the venous blood from most of the superolateral surface of the brain and drains typically into the cavernous sinus as mentioned in standard textbooks. But the drainage of the SMCV is variable as indicated by various radiological studies. Although variations in the drainage of the SMCV exist, there is a shortage in the literature providing cadaveric evidence for the same. The present study was designed to identify the variations in the drainage pattern of the SMCV in fetal cadavers. During the dissection of formalin-fixed full-term fetuses, deviation in the drainage of the SMCV was observed in five out of 30 cases. In three out of 30 specimens (10%), SMCV was observed draining into superior petrosal sinus; and in two specimens (6.6%) into the transverse sinus. In the remaining specimens, the SMCV drained directly into the cavernous sinus. Knowledge of the variations noted in the present study is essential, not only for diagnosing several diseases involving the cavernous sinus or paracavernous sinuses but also in surgeries of paracavernous sinus lesions and endovascular treatment of arteriovenous fistulas. The SMCV and superior petrosal sinus can be a venous refluxing route in patients with arteriovenous fistulas.

A Case Of Cavernous Sinus Syndrome and Mutifocal Cerebral Infarction Related To Mucormycosis Of Sphenoid Sinus

전석원,권재환,김창회,김주연 고신대학교(의대) 고신대학교 의과대학 학술지 2018 고신대학교 의과대학 학술지 Vol.33 No.3

A 54-year-old man, suffering from severe headache and ophthalmoplegia after undergoing endoscopic sinus surgery was referred to a tertiary hospital. Computed tomography (CT) revealed soft tissue density lesions in the left sphenoid sinus. The internal carotid artery was shown to be occluded in brain magnetic resonance imaging (MRI) scans without any other cerebral lesion. Endoscopic view of left nasal cavity shows whitish hyphae in the ethmoid and the sphenoid sinuses. We diagnosed him with cavernous sinus syndrome caused by mucormycosis and conducted endoscopic sinus surgery to remove remaining lesions and decompress orbit and optic nerves. After the revision surgery the patient’s headache and ophthalmoplegia were improved. However, multifocal cerebral infarctions were newly discovered in a postoperative CT scan. We experienced a case of mucormycosis of sphenoid sinus resulting in occlusion of internal carotid artery and multifocal cerebral infarction, and report it with a brief review of these disease entities.

해면 정맥동 미세 수술 해부학(사체연구) : 전측방 및 전상방 접근법 Anterolateral and Anterosuperior Approach

이종수 인제대학교 1997 仁濟醫學 Vol.18 No.1

4 사체 표본(cadaver specimens)을 이용하여 해면 정맥동에 대해 다음의 2가지 접근법을 시행하고 해부학적 연구를 하였다 : 1)전상상 돌기, 상안와열, 정원공, 난원공, 및 가시공 등 각각의 신경 및 혈관 탈출공에 대한 감압 후 시신경, 내경 동맥의 전굴부(anterior genu) 및 해면 정맥동의 내막과 추체부 내경 동맥의 후굴부(posterior genu)를 노출 시키기 위한 전측방 경막외 접근법 2)측두 첨부 접근으로 해면 정맥동부 내경 동맥과 뇌하수체 노출을 위한 전상방 경막내 접근법. 단일 접근법으로 해면 정맥동의 모든 부위에 도달하는 것은 힘들기는 하지만, 전측방 경막외 접근 및 전상방 경막내 접근법을 종합하여 뇌손상 없이 해면 정맥동 및 그 주위 조직에 대한 최대한의 노출이 가능하였다. The purpose of the dissections was not only to add to the wealth of anatomical information but also to study the efficacy of anterolateral extradural and anterosuperior intradural approach to the cavernous sinus. The usefulness of anterolateral and anterosuperior approach to the cavernous sinus combined with temporopolar approach were studied in 4 cadaver specimens(2 heads). The following approach were examined : 1)the anterolateral extradural approach for exposure of the lateral inner membrane of the sinus and the petrosal portion of the internal carotid artery 2)the anterosuperior intradural approach combined with a temporopolar approach. It was clear that a single approach was not capable of providing access to all parts of the sinus. The intracavernous structures best exploded by combining each route are reviewed. Surgeon who perform operations in and around the cavernous sinus for neoplastic and vascular lesions will find these studies useful.

급성 부비동염 후 발생한 해면정맥동 혈전염에 합병된 동안과 외전 신경마비

강주용,김정준,최익준,이명철 대한이비인후과학회 2019 대한이비인후과학회지 두경부외과학 Vol.62 No.12

Cavernous sinus thrombophlebitis is a rare complication of paranasal sinusitis. The diseasecan result in a fatal outcome if not treated with proper antibiotics or surgical intervention. Recently,we experienced a case, in which a 58-year-old female presented with oculomotor andabducens nerve palsy resulting from the cavernous sinus thrombophlebitis complicated by paranasalsinusitis. CT and magnetic resonance imaging with contrast enhancement showed rightunilateral pansinusitis, left maxillary, ethmoid and sphenoid sinusitis and bilateral cavernoussinus thrombophlebitis. These conditions were resolved by endoscopic sinus surgery, administrationof broad spectrum antibiotics and steroid.

Tolosa-Hunt증후군의 MR소견

이지윤 대한영상의학회 1995 대한영상의학회지 Vol.32 No.3

Purpose: To assess the MR findings of Tolosa-Hunt syndrome and to evaluat differential point of cavernous sinus lesions. Materials and methods: Eleven cases of Tolosa-Hunt syndrome were evaluated by MRI with specific regard to the shape of cavernous sinus, signal intensity, and pattern of enhancement. Other associated findings were also anlaysed. Results: Two patients had normal MR features of the cavernous sinus. When compared with the contralateral normal cavernous sinus, the involved cavernous sinus was enlarged in six of the nine patients. The outer dural margin was convex and bulged laterally in 6 cases, flat in 2 cases, and concave in 1case. Of the nine patients, five had iso-signal intensity and four had low signal intensity relative to gray matter on short TR/short TE. Three had isosignal intensity and 6 were not detectale on long TR/short and long TE pulse sequence. Contrast enhancement was seen in 8 cases; 7cases showed homogeneous enhancement, 1 case heterogeneous enhancement. Conclusion: In the appropriate clinical setting of painful ophthalmoplegia, MR findings of cavernous sinus abnormality that consist of iso to low signal intensity on short TR/short TE images and isointense orundetectale mass on long TR/short TE or long TR/long TE images may suggest the dignosis of Tolosa-Hunt syndrome.