Transcavernous Approach to the Upper Basilar and Retroclival Area-Cadaveric Surgical Simulation Video: 2-Dimensional Operative Video.

Abstract

The transcavernous approach (TcA) is an extension of the pterional approach that widens access to the central and lateral skull base regions. Through working between the nerves and vascular structures within the cavernous sinus, the TcA enables enhanced exposure of areas and structures including but not limited to the retrosellar area, Meckel's cave, and the basilar trunk. When the basilar apex and retrosellar regions are targeted, the TcA offers a valuable solution to the problem of the restricted space between the neurovascular structures of the central skull base through opening and widening the 2 major triangles of the cavernous sinus roof: the clinoidal and oculomotor triangles. Mastery of this approach requires careful review of the anatomy and much time spent in the cadaver lab. Although many quantitative studies and illustrative papers exist on the technical nuances of the TcA to the basilar apex region, the TcA is still difficult to understand, learn, and undertake. This cadaveric surgical simulation attempts to facilitate this objective. Of note, we have demonstrated and discussed the specific variant of the TcA that aims to reach the basilar apex area, and this video does not include the full TcA that also involves complete exposure of the lateral aspect of the cavernous sinus and the Meckel's cave.