Elements of the epidural approach to the parasellar space and adjacent regions in the central skull base



The patient is placed supine for surgery, with the head rotated 30–35 degrees toward the side opposite the lesion and stabilized in the three-point Mayfield fixation device. The neck is neither extended nor flexed, but the head positioned so that the superior orbital rim and malar eminence are uppermost. During the course of surgery, the long axis of the operating table is tilted from its initial position to the Trendelenburg or reverse Trendelenburg position of the patient (Fig. 2.1), and/or rotated right or left as necessary to expose the central skull base to best advantage (Fig. 2.2), and the position of the operating microscope is shifted accordingly in the opposite direction (Figs. 2.1 and 2.2).


Middle Cranial Fossa Optic Canal Middle Meningeal Artery Petrous Apex Diamond Burr 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Dolenc V.V. (1983) Direct microsurgical repair of intracavernous vascular lesions. J Neurosurg 58: 824–831PubMedCrossRefGoogle Scholar
  2. 2.
    Dolenc V.V. (1985) A combined epi-and subdural direct approach to carotidophthalmic artery aneurysms. J Neurosurg 62: 667–672PubMedCrossRefGoogle Scholar
  3. 3.
    Dolenc V.V. (1989) Anatomy and surgery of the cavernous sinus. Springer, Wien New York, pp 1–344CrossRefGoogle Scholar
  4. 4.
    Dolenc V.V., Škrap M., Šušteršič J., Škrbec M., Morina A. (1987) A transcavernous-transsellar approach to the basilar tip aneurysms. Br J Neurosurg 1: 251–259PubMedCrossRefGoogle Scholar
  5. 5.
    Glasscock M.E. (1969) Exposure of the intra-petrous portion of the carotid artery. In: Hamberger C.A., et al (eds) Disorders of the skull base region. Proceedings of the Tenth Nobel Symposium. Almqvist & Wiksell, Stockholm, pp 135–143Google Scholar
  6. 6.
    Kawase T., Toya S., Shiobara R., Kimura C., Nakajima H. (1987) Skull base approaches for meningiomas invading the cavernous sinus. In: Dolenc V.V. (ed) The cavernous sinus. A multidisciplinary approach to vascular and tumorous lesions. Springer, Wien New York, pp 346–354Google Scholar
  7. 7.
    Lesoin F., Pellerin P., Autricque A., Clarisse J., Jomin M. (1987) The direct microsurgical approach to intracavernous tumours. In: Dolenc V.V. (ed) The cavernous sinus. A multridisciplinary approach to vascular and tumorous lesions. Springer, Wien New York, pp 323–331Google Scholar
  8. 8.
    Parkinson D. (1965) A surgical approach to the cavernous portion of the carotid artery. Anatomical studies and case report. J Neurosurg 23: 474–483PubMedCrossRefGoogle Scholar
  9. 9.
    Parkinson D (1973) Carotid cavernous fistula: direct repair with preservation of the carotid artery. J Neurosurg 38: 99–106PubMedCrossRefGoogle Scholar
  10. 10.
    Parkinson D (1988) Surgical management of internal carotid artery aneurysms within the cavernous sinus. In: Schmidek H.H. et al (eds) Operative neurosurgical techniques. Indications, methods and results. Grune & Stratton, Orlando, FL, pp 837–844Google Scholar
  11. 11.
    Pool J.L., Potts D.G. (1965) Aneurysms and arteriovenous anomalies of the brain: diagnosis and treatment. Harper & Row, Nex York, p 307Google Scholar
  12. 12.
    Taptas J.N. (1982) The so-called cavernous sinus: a review of the controversy and its implications for neurosurgeons.Neurosurgery 11: 712–717PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 2003

Authors and Affiliations

  1. 1.Department of NeurosurgeryUniversity Medical Centre LjubljanaSlovenia

Personalised recommendations