Dolenc's triangle [Neurosurgery Wiki]

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====== Dolenc's triangle ======

Its borders are the [[optic nerve]], [[oculomotor nerve]], [[tentorial edge]] (and the dura extending between the dural entry point of the [[third cranial nerve]] and the [[optic nerve]])
((Watanabe A, Nagaseki Y, Ohkubo S, Ohhashi Y, Horikoshi T, Nishigaya K, Nukui H. Anatomical variations of the ten [[triangles]] around the [[cavernous sinus]]. Clin Anat. 2003 Jan;16(1):9-14. doi: 10.1002/ca.10072. PMID: 12486732.)).

Its contents are the clinoidal [[internal carotid artery]] (ICA) and the [[anterior clinoid process]].

Drilling the [[anterior clinoid process]], either extradurally or intradurally exposes the clinoidal or [[anteromedial triangle]] area. It is bordered by the [[optic nerve]] medially, [[oculomotor nerve]] laterally, and the tentorial edge extending between the second and third cranial nerves at the base. Watanabe, et al. found that the average measurements of the medial border, lateral border, base, and the area are 9.5, 13.3, 7.2 mm and 32.3 mm2, respectively
((Watanabe A, Nagaseki Y, Ohkubo S, Ohhashi Y, Horikoshi T, Nishigaya K, Nukui H. Anatomical variations of the ten [[triangles]] around the [[cavernous sinus]]. Clin Anat. 2003 Jan;16(1):9-14. doi: 10.1002/ca.10072. PMID: 12486732.)).

These dimensions have been further explored via microsurgical techniques on cadaveric dissections and the average sizes of the medial border, lateral border, base, and area are 7.34, 13.89, 8.53 mm and 26.25 mm2, respectively 
((Isolan GR, Krayenbühl N, de Oliveira E, Al-Mefty O. Microsurgical Anatomy of the Cavernous Sinus: Measurements of the Triangles in and around It. Skull Base. 2007 Nov;17(6):357-67. doi: 10.1055/s-2007-985194. PMID: 18449336; PMCID: PMC2117623.)).

Day and Fukushima described the anterior triangle as defined by the lateral border of the optic nerve, the medial wall of the superior orbital fissure dura, and the dural ring surrounding the internal carotid artery (ICA) as it enters the subarachnoid space. According to these borders, they measured the dimensions as 6.30 posteriorly, 6.88 medially, and 8.72 mm laterally
((Innovations in surgical approach: lateral cranial base approaches. Day JD, Fukushima T, Giannotta SL. https://www.ncbi.nlm.nih.gov/pubmed/9247796. Clin Neurosurg. 1996;43:72–90.))
((Direct operative approach to the vascular lesions in the cavernous sinus: summary of 27 cases. Mt Fuji Workshop. Fukushima T. Cerebrovasc Dis. 1988;6:169–189.)).

Although these various authors differ in their measurements, they agree about this triangle’s content: the clinoidal segment of the ICA in the middle, optic strut anteriorly, and the roof of the cavernous sinus posteriorly. To reach the clinoidal ICA, the anterior clinoid process can be pneumatized so that the clinoidal ICA can be visualized
((Umansky F, Valarezo A, Elidan J. The superior wall of the cavernous sinus: a microanatomical study. J Neurosurg. 1994 Dec;81(6):914-20. doi: 10.3171/jns.1994.81.6.0914. PMID: 7965122.)).