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61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

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Microsurgical and histological analysis of a temporal meningeal and periosteal dural incision zone for interdural exposure of the dorsolateral cavernous sinus

Meeting Abstract

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  • Peter Spangenberg - Department of Neurosurgery, Ruhr University Bochum, Germany
  • Andreas Prescher - Department of Anatomy, Technical University Aachen, Germany
  • Andreas Kinzel - Department of Neurosurgery, Ruhr University Bochum, Germany
  • Martin Scholz - Department of Neurosurgery, Städtische Kliniken Duisburg, Germany
  • Albrecht Harders - Department of Neurosurgery, Ruhr University Bochum, Germany

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocV1556

doi: 10.3205/10dgnc033, urn:nbn:de:0183-10dgnc0338

Published: September 16, 2010

© 2010 Spangenberg et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: The purpose of this study was to further elucidate the microsurgical dural architecture of the middle fossa temporal dura related to the interdural exposure of the dorsolateral cavernous sinus wall.

Methods: 20 human cadaveric heads were examined on both sides through a classical frontotemporal approach. The lateral middle fossa bone was shaved flat and the temporal dura was elevated towards the meningoorbital band, the superior orbital fissure, the foramen rotundum, ovale and spinosum. At the site of the trigeminal foramina, the dura was superficially incised to separate the periosteal and meningeal dura layers. The length, course and extent of this dural zone allowing dural layer separation was determined in all specimen. The meningeal dural layer was elevated to the incisura tentorii, and the roof of the cavernous sinus was exposed. The dimensions of the interdural cleavage plane above the trigeminal nerve, ganglion and branches were determined.

The dural layer architecture was investigated histologically around the interdural incision zone in 5 specimen.

Results: In all specimen, meticulous superficial incision of the temporal dura lateral to the trigeminal foramina allowed separation of the 2 meningeal layers. This interdural incision zone (IIZ) ranged from 5 to 6,4 cm in length and surpassed the superior orbital fissure medially and the foramen spinosum laterally by 6 and 5 mm, respectively. Between the trigeminal foramina, the IIZ had a curved course. Separation of the dural layers along this zone allowed easy elevation of the temporal meningeal dura and exposure of the cavernous sinus roof. The histological sections revealed a one thick dura layer – resembling like on layer –, above and a two-layerd dura below the IIZ.

Conclusions: The architecture of the middle fossa temporal dura allows microsurgical separation of the 2 dural layers for a length of 5 to 6 cm along the lateral edges of the trigeminal foramina. Opening the interdural cleavage plane through this interdural incision zone facilitates wide exposure of the cavernous sinus roof.