Refining the posterior compartment of the cavernous sinus: a detailed reappraisal of surgical anatomy and techniques for invasive pituitary adenoma resection
In brief
Posterior cavernous sinus is triangular in two thirds of cases, informing endoscopic tumor access
Dissection of 39 cadaveric heads showed the posterior compartment of the cavernous sinus has a triangular shape in 67% of hemispheres and a quadrilateral shape in the remainder, with key ligaments present in 64-78% of specimens. These anatomic patterns define safe corridors for endoscopic endonasal resection of invasive pituitary adenomas, though clinical validation is still needed.
- Journal
- Journal of neurosurgery (Q1)
- Published
- 28 August 2026
- Study design
- Unclassified
- Evidence level
- Level 5, Expert Opinion (CEBM 5)
- Authors
- Yuanzhi Xu, Tatsuya Uchida, Erik Burgos-Sosa, Ana Sofia Alvarez, Mariano Rinaldi, Taishi Nakase, et al.
- PMID
- 42664526
- DOI
- 10.3171/2026.4.JNS252898
Why clinicians should know about it
- Picked for Anatomy (paper of the day, 3 September 2026): Detailed reappraisal of posterior cavernous sinus surgical anatomy
Abstract
OBJECTIVE: Access to the posterior compartment of the cavernous sinus (CS) remains one of the greatest challenges via endoscopic endonasal surgery because of its deep location behind the posterior genu of the internal carotid artery (ICA) and the complex neurovascular ligamentous structures it contains. To date, no comprehensive anatomical study has focused specifically on the posterior compartment of the CS from the perspective of an endoscopic endonasal approach (EEA). The aim of this study was to delineate the microsurgical anatomy and technical nuances critical for safely accessing this compartment via the EEA. METHODS: Thirty-nine colored silicone-injected cadaveric heads were dissected, 19 via a transcranial approach and 20 via an EEA. Two illustrative surgical cases were also reviewed to highlight anatomical landmarks and strategies for tumor resection within the posterior compartment of the CS. RESULTS: The posterior compartment exhibited a triangular configuration in 66.7% of hemispheres and a quadrilateral shape in 33.3%, depending on the angulation of the ICA posterior genu. The posterior parasellar ligament was present in 64% of hemispheres, with 42% displaying a two-anchor configuration and 58% a net-like morphology. The posterior petroclinoid ligament, a dural fold marking the transition from the roof to the posterior wall of the CS, showed a smooth slope in 76% and ossification at attachment sites in 69%. Gruber's ligament, a periosteal dural extension from the posterior clinoid base to the petrous apex, appeared as a robust membranous band in 78% of hemispheres and as ossified in 59%. Potential spaces around Gruber's ligament may serve as key corridors for tumor invasion and remnants. Four venous outlets of the posterior compartment, draining into the basilar plexus, foramen lacerum plexus, inferior petrosal sinus, and superior petrosal sinus, were consistently identified. CONCLUSIONS: This study provides a systematic description of the posterior compartment of the CS from an EEA perspective, clarifying its ligamentous, arterial, and venous architecture and offering critical insights for safe and effective tumor resection.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.