{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T02:44:42Z","timestamp":1783651482140,"version":"3.55.0"},"reference-count":49,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2023,8,17]],"date-time":"2023-08-17T00:00:00Z","timestamp":1692230400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Background: The cavernous sinus (CS) is a highly vulnerable anatomical space, mainly due to the neurovascular structures that it contains; therefore, a detailed knowledge of its anatomy is mandatory for surgical unlocking. In this study, we compared the anatomy of this region from different endoscopic and microsurgical operative corridors, further focusing on the corresponding anatomic landmarks encountered along these routes. Furthermore, we tried to define the safe entry zones to this venous space from these three different operative corridors, and to provide indications regarding the optimal approach according to the lesion\u2019s location. Methods: Five embalmed and injected adult cadaveric specimens (10 sides) separately underwent dissection and exposure of the CS via superior eyelid endoscopic transorbital (SETOA), extended endoscopic endonasal transsphenoidal-transethmoidal (EEEA), and microsurgical transcranial fronto-temporo-orbitozygomatic (FTOZ) approaches. The anatomical landmarks and the content of this venous space were described and compared from these surgical perspectives. Results: The oculomotor triangle can be clearly exposed only by the FTOZ approach. Unlike EEEA, for the exposure of the clinoid triangle content, the anterior clinoid process removal is required for FTOZ and SETOA. The supra- and infratrochlear as well as the anteromedial and anterolateral triangles can be exposed by all three corridors. The most recently introduced SETOA allowed for the exposure of the entire lateral wall of the CS without entering its neurovascular structures and part of the posterior wall; furthermore, thanks to its anteroposterior trajectory, it allowed for the disclosure of the posterior ascending segment of the cavernous ICA with the related sympathetic plexus through the Mullan\u2019s triangle, in a minimally invasive fashion. Through the anterolateral triangle, the transorbital corridor allowed us to expose the lateral 180 degrees of the Vidian nerve and artery in the homonymous canal, the anterolateral aspect of the lacerum segment of the ICA at the transition zone from the petrous horizontal to the ascending posterior cavernous segment, surrounded by the carotid sympathetic plexus, and the medial Meckel\u2019s cave. Conclusions: Different regions of the cavernous sinus are better exposed by different surgical corridors. The relationship of the tumor with cranial nerves in the lateral wall guides the selection of the approach to cavernous sinus lesions. The transorbital endoscopic approach can be considered to be a safe and minimally invasive complementary surgical corridor to the well-established transcranial and endoscopic endonasal routes for the exposure of selected lesions of the cavernous sinus. Nevertheless, peer knowledge of the anatomy and a surgical learning curve are required.<\/jats:p>","DOI":"10.3390\/brainsci13081215","type":"journal-article","created":{"date-parts":[[2023,8,17]],"date-time":"2023-08-17T10:15:48Z","timestamp":1692267348000},"page":"1215","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["A New Perspective on the Cavernous Sinus as Seen through Multiple Surgical Corridors: Anatomical Study Comparing the Transorbital, Endonasal, and Transcranial Routes and the Relative Coterminous Spatial Regions"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4918-6857","authenticated-orcid":false,"given":"Sergio","family":"Corvino","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Universita\u0300 di Napoli \u201cFederico II\u201d, 80131 Naples, Italy"},{"name":"PhD Program in Neuroscience, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Universita\u0300 di Napoli \u201cFederico II\u201d, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro L.","family":"Villanueva-Sol\u00f3rzano","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, National Institute of Neurology and Neurosurgery \u201cManuel Velasco Suarez\u201d, Mexico City 14269, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Offi","sequence":"additional","affiliation":[{"name":"Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli, 00168 Rome, Italy"},{"name":"Division of Neurosurgery, Catholic University of Rome, 00153 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6550-5534","authenticated-orcid":false,"given":"Daniele","family":"Armocida","sequence":"additional","affiliation":[{"name":"Neurosurgery Division, Human Neurosciences Department, \u201cSapienza\u201d University, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Motonobu","family":"Nonaka","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kochi University Hospital, 185-1, Oko-cho, Kohasu, Kochi 783-8505, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6924-3551","authenticated-orcid":false,"given":"Giorgio","family":"Iaconetta","sequence":"additional","affiliation":[{"name":"Neurosurgical Clinic A.O.U. \u201cSan Giovanni di Dio e Ruggi d\u2019Aragona\u201d, 84131 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1051-5924","authenticated-orcid":false,"given":"Felice","family":"Esposito","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Universita\u0300 di Napoli \u201cFederico II\u201d, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi Maria","family":"Cavallo","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Neuroscience and Reproductive and Odontostomatological Sciences, Universita\u0300 di Napoli \u201cFederico II\u201d, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo de","family":"Notaris","sequence":"additional","affiliation":[{"name":"Neurosurgery Operative Unit, Department of Neuroscience, Coordinator Neuroanatomy Section Italian Society of Neurosurgery, G. Rummo Hospital, 82100 Benevento, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2857","DOI":"10.1007\/s10143-020-01470-5","article-title":"Transorbital endoscopic approaches to the skull base: A systematic literature review and anatomical description","volume":"44","author":"Vural","year":"2021","journal-title":"Neurosurg. Rev."},{"key":"ref_2","first-page":"1821","article-title":"The feasibility of three port endonasal, transorbital, and sublabial approach to the petroclival region: Neurosurgical audit and multiportal anatomic quantitative investigation","volume":"165","author":"Corvino","year":"2023","journal-title":"Acta Neurochir."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"474","DOI":"10.3171\/jns.1965.23.5.0474","article-title":"A surgical approach to the cavernous portion of the carotid artery. 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Head Neck Surg."}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/13\/8\/1215\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:36:10Z","timestamp":1760128570000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/13\/8\/1215"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,17]]},"references-count":49,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2023,8]]}},"alternative-id":["brainsci13081215"],"URL":"https:\/\/doi.org\/10.3390\/brainsci13081215","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,17]]}}}