[Microsurgical anatomy of the transoval percutaneous route to the trigeminal cave and the trigeminal ganglion]. / Anatomie microchirurgicale de la voie percutanée transovale vers la cavité trigéminale et le ganglion trigéminal (voie de Hartel).

The percutaneous Hartel transoval route goes through an inverted pyramid, with an inferior summit and a superior base that includes three compartments. The danger of the inferior compartment is the parotid duct. The middle compartment contains many branches of the mandibular nerve. The superior compartment is crossed by the internal maxillary artery and its branches, as well as the auditory tube. The base of the pyramid presents not only the foramen ovale, but also the foramen lacerum, where the trocar may injure the internal carotid, and the foramen jugulare, where the trocar may meet the internal jugular vein and nerves of the pars nervosa (IX, X, XI). The trigeminal cave contains, within the trigeminal cistern, the trigeminal ganglion, extended backward by the triangular plexus (the target for thermocoagulation). These structures are undercrossed by the masticatory motor branch of the trigeminal nerve.

Visual outcome after surgery for cavernous sinus meningioma.

BACKGROUND: Extension of cavernous sinus meningiomas can compromise vision by compressing the optic nerves and chiasm. Surgical tumour removal aims to protect vision in the long-term. However, the risks of surgery include transient or permanent damage to the anterior visual pathways. This study aims to 1) analyse the visual status in unilateral cavernous sinus meningioma with extra-cavernous extension, before and after removal of the extra-cavernous portion, without any adjuvant treatment with radiotherapy, 2) identify pre-surgical and early post-surgical prognostic factors for long-term visual outcome and 3) compare these results to previous studies. METHODS: This is a retrospective study of 30 consecutive patients who underwent surgery between 1989 and 2004. Visual acuity, visual fields, and fundi were evaluated before surgery and during the mean follow-up period of 2 years. FINDINGS: Total visual loss occurred in the ipsilateral eye following surgery in 10% of patients. There was improvement in vision in 23%, no significant change in 27% and worsening in 50% of patients. Pre-surgical visual acuity was not predictive of final visual outcome, but initial optic disc pallor was a poor prognostic factor. In pre-operatively normal contralateral eyes, 10% developed a mild visual deficit (visual acuity = 20/32 or better, and visual field defect