The first report of successful intracavernous surgery was that of Browder.1 A carotid-cavernous fistula was reported cured by packing muscle through an incision in the roof of the cavernous sinus. However, it was not until the work of Parkinson and Ramsay13 that the “inoperability” of the cavernous sinus was seriously challenged. They described an approach into the posterior cavernous sinus through a triangle which now bears Parkinson's name, bordered by the oculomotor and trochlear nerves superiorly and the trigeminal and abducens nerves inferiorly. The inherent risks of circulatory arrest and the method used to achieve vascular control in these procedures dissuaded others from adopting this technique. More recently, drawing upon existing knowledge as well as extensive personal research, Dolenc2 reported a method of cavernous sinus exploration without the need for circulatory arrest.
Utilizing the work of Parkinson,10–13 Dolenc,2,3 and other pioneering investigators, we have developed a comprehensive surgical approach for the treatment of lesions of the cavernous sinus. This report attempts to distill the seemingly complex Dolenc technique into a series of 12 simple steps in order to promote the practical application of this information. These steps may be used in whole for total exploration of the cavernous sinus, but also in part for lesions that involve only limited regions of the cavernous sinus.
Parkinson D: A surgical approach to the cavernous portion of the carotid artery. Anatomical studies and case report. J Neurosurg 23:474–4831965Parkinson D: A surgical approach to the cavernous portion of the carotid artery. Anatomical studies and case report. J Neurosurg 23:
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