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Albert L. Rhoton Jr., Jack L. Pulec, George M. Hall and Allen S. Boyd Jr.

petrosal nerve, for which it may be mistaken. When such a bony defect is viewed from the side, as in the usual extradural subtemporal approach for trigeminal neuralgia, the irregularities of the floor of the middle fossa could hide it or make it barely perceptible. Because bleeding may result from elevation of the dura and avulsion of the petrosal branch of the middle meningeal artery from its entrance into the facial hiatus, 4 it is easy to understand why electrocoagulation might be used in close proximity to the exposed facial nerve. This vessel usually bleeds when

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Anatomy of the cavernous sinus

A microsurgical study

Frank S. Harris and Albert L. Rhoton Jr.

tear in an arterial branch of the carotid such as the inferior hypophyseal artery or by avulsion of a small capsular artery from the carotid artery. References 1. Bedford MA : The “cavernous” sinus. Br J Ophthalmol 50 : 41 – 46 , 1966 Bedford MA: The “cavernous” sinus. Br J Ophthalmol 50: 41–46, 1966 2. Bernasconi V , Cassinari V : Caratteristische angiografiche dei meningiomi del tentorio. Radiol Med 43 : 1015 – 1026 , 1957 Bernasconi V, Cassinari V: Caratteristische angiografiche

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Wayne S. Paullus, T. Glenn Pait and Albert L. Rhoton Jr.

ganglion is not readily noted during middle fossa surgical approaches. When exposed by the absence of bone, the genu and ganglion do not protrude from the bone defect, but remain flush with or slightly depressed from the surrounding bone surface. When such a bone defect is viewed from the side, as in the usual extradural subtemporal approach for trigeminal neuralgia, the irregularities of the floor of the middle fossa could hide it or make it barely perceptible. Because bleeding may result from elevation of the dura and avulsion of the petrosal branch of the middle

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Juan C. Fernandez-Miranda, Paul A. Gardner, Milton M. Rastelli Jr., Maria Peris-Celda, Maria Koutourousiou, David Peace, Carl H. Snyderman and Albert L. Rhoton Jr.

cavernous ICA, preventing any risk for avulsion of the IHA from the ICA wall. Occasionally, we have encountered an IHA with a long loopy trajectory that facilitates dissection, mobilization, and preservation of the artery. Blunt dissection is employed to develop the transcavernous corridor between the cavernous ICA and the pituitary gland, with more emphasis on the medial mobilization of the pituitary gland than on the lateral mobilization of the cavernous ICA ( Fig. 3 ). Occasionally, the cavernous ICA might be adherent to the medial wall of the cavernous sinus, which