Neurovascular structures at risk during surgical access to trigeminal ganglion and meckel's cave – An anatomical study

Chaware, Prashant; Kumar, Venkatasurya; Srivastava, Ankit; Raj, Sumit; D. Rathinam, Bertha A

Neurovascular structures at risk during surgical access to trigeminal ganglion and meckel's cave – An anatomical study

Authors

¹ Department of Anatomy, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India

² Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India

Abstract

Background: It is difficult to approach the Trigeminal Ganglion (TG) and Meckel's cave (MC) during surgeries. Therefore, the exact knowledge of the relationship of surgical landmarks to related anatomical structures is vital to reduce the associated postoperative morbidity. The aim of the present study was to enhance the knowledge of the surgical anatomy of structures that are present in the conduit of all surgical approaches to TG and MC, their distances from surrounding neurovascular structures, and their variations.
Material and Methods: The study was carried out on 40 embalmed cadavers (Eight Female) of the anatomy department of a teaching hospital in Central India. Meticulous dissection of cranial fossae was done to locate TG, MC, and related anatomical structures. All distances from TG and MC were measured using an electronic digital calliper.
Results: Length, width, and thickness of TG were 15.39 mm, 4.39 mm, and 2.54 mm, respectively. The distance from zygomatic arch, the lateral end of the petrous ridge, arcuate eminence, foramen ovale, and foramen spinosum to MC was 26.10 mm and 37.94 mm, 16.46 mm, 4.54 mm, and 11.23 mm, respectively. The sixth, fourth, and third cranial nerves were 6.26 mm, 4.94 mm, and 2.53 mm from MC, respectively. The MC was 42.72 mm and 33.87 mm anteromedial from posterior and anterior limits of the sigmoid sinus.
Conclusion: Findings of the present study will aid surgical planning and decide the approach to TG and MC and avoid surgical complications.

Keywords

References

1.	Standring S. Cranial cavity. In: Gray's Anatomy; The Anatomical Basis of Clinical Practice. 42^nd ed. Edinburg: Elsevier Churchill Livingstone; 2020. p. 435-54.
2.	Datta AK. Interior of the cranium. In: Essentials of Human Anatomy, Head and Neck. 6^th ed. Kolkata: Current Books International; 2017. p. 182-4.
3.	Messlinger K, Russo A. Current understanding of trigeminal ganglion structure and function in headache. Cephalalgia 2019;39:1661-74.
4.	Messlinger K, Balcziak L, Russo A. Cross-talk signaling in the trigeminal ganglion: Role of neuropeptides and other mediators. J Neural Transm (Vienna) 2020;127:431-44.
5.	Kontzialis M, Kocak M. Imaging evaluation of trigeminal neuralgia. J Istanb Univ Fac Dent 2017;51 (3 Suppl 1):S62-8.
6.	Montano N, Conforti G, Di Bonaventura R, Meglio M, Fernandez E, Papacci F. Advances in diagnosis and treatment of trigeminal neuralgia. Ther Clin Risk Manag 2015;11:289-99.
7.	Katheriya G, Chaurasia A, Khan N, Iqbal J. Prevalence of trigeminal neuralgia in Indian population visiting a higher dental care center in North India. Natl J Maxillofac Surg 2019;10:195-9. [PUBMED] [Full text]
8.	Goel A, Nadkarni T. Basal lateral subtemporal approach for trigeminal neurinomas: Report of an experience with 18 cases. Acta Neurochir (Wien) 1999;141:711-9.
9.	Taha JM, Tew JM, van Loveren HR, Keller JT, El-Kalliny M. Comparison of conventional and skull base surgical approaches for the excision of trigeminal neurinomas. J Neurosurg 1995;82:719-25.
10.	Chui M, Tucker W, Hudson A, Bayer N. High resolution CT of Meckel's cave. Neuroradiology 1985;27:403-9.
11.	Samii M, Carvalho GA, Tatagiba M, Matthies C. Surgical management of meningiomas originating in Meckel's cave. Neurosurgery 1997;41:767-75.
12.	Goel A. Middle fossa sub-Gasserian ganglion approach to clivus chordomas. Acta Neurochir (Wien) 1995;136:212-6.
13.	Daniels DL, Pech P, Pojunas KW, Kilgore DP, Williams AL, Haughton VM. Trigeminal nerve: Anatomic correlation with MR imaging. Radiology 1986;159:577-83.
14.	Kapila A, Chakeres DW, Blanco E. The Meckel cave: Computed tomographic study. Part I: Normal anatomy; Part II: Pathology. Radiology 1984;152:425-33.
15.	Rubinstein D, Stears RL, Stears JC. Trigeminal nerve and ganglion in the Meckel cave: Appearance at CT and MR imaging. Radiology 1994;193:155-9.
16.	Yousry I, Camelio S, Wiesmann M, Schmid UD, Moriggl B, Brückmann H, et al. Detailed magnetic resonance imaging anatomy of the cisternal segment of the abducent nerve: Dorello's canal and neurovascular relationships and landmarks. J Neurosurg 1999;91:276-83.
17.	Arslan M, Deda H, Avci E, Elhan A, Tekdemir I, Tubbs RS, et al. Anatomy of Meckel's cave and the trigeminal ganglion: Anatomical landmarks for a safer approach to them. Turk Neurosurg 2012;22:317-23.
18.	Ajayi NO, Lazarus L, Satyapal KS. Trigeminal cave and ganglion: An anatomical review. Int J Morphol 2013;31:1444-8.
19.	Henderson WR. The anatomy of the gasserian ganglion and the distribution of pain in relation to injections and operations for trigeminal neuralgia. Ann R Coll Surg Engl 1965;37:346-73.
20.	Soeira G, Abd El-Bary TH, Dujovny M, Siavin KV, Ausman JI. Microsurgical anatomy of the trigeminal nerve. Neurol Res 1994;16:273-83.
21.	Koshi R. The cranial cavity. In: Cunninghan's Manual of Practical Anatomy, Head, Neck and Brain. 16^th ed. Oxford United Kingdom: Oxford University Press; 2018. p. 73-91.
22.	Janjua RM, Al-Mefty O, Densler DW, Shields CB. Dural relationships of Meckel cave and lateral wall of the cavernous sinus. Neurosurg Focus 2008;25:E2.
23.	Day JD, Fukushima T, Giannotta SL. Microanatomical study of the extradural middle fossa approach to the petroclival and posterior cavernous sinus region: Description of the rhomboid construct. Neurosurgery 1994;34:1009-16; discussion 1016.
24.	Giddings NA, Brackmann DE, Kwartler JA. Transcanal infracochlear approach to the petrous apex. Otolaryngol Neck Surg 1991;104:29-36.
25.	Haberkamp TJ. Surgical anatomy of the transtemporal approaches to the petrous apex. Otol Neurotol 1997;18:501-6.
26.	Miller CG, Van Loveren HR, Keller JT, Pensak M, El-Kalliny M, Tew Jr JM. Transpetrosal approach: Surgical anatomy and technique. Neurosurgery 1993;33:461-9.

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