This approach does not allow access to the cavernous sinus but provides excellent decompression of the optic nerves. For a long time surgery within the cavernous sinus was considered too risky because of concern about bleeding from the veins and injury to the delicate neurovascular structures within it. With improved knowledge of the surgical anatomy and new microsurgical techniques the cavernous sinus can be opened and the tumor removed. While this approach allows excellent access to the cavernous sinus and region above the sella turcica, it is limited to only one side and does not provide access to the region below the pituitary gland. Craniotomy outlined for the transcavernous approach.
Additional bone removed at the skull base is depicted by cross-hatching.
The operation is similar to the transsphenoidal route with a much greater exposure of the skull base. Once the separated maxilla is down-fractured, the tumor removal is performed through the back of the mouth and nasal area. At the end of the surgery, the maxilla bone is reattached using small titanium plates and screws. Red area depicts the wide area of exposure obtained with the Le Fort maxillotomy. Sometimes this difficulty arises because the surgeon s view of the tumor is incomplete using any single approach.