• Ricardo L L Dolci, Ricardo L Carrau, Lamia Buohliqah, Matteo Zoli, Paulo M Mesquita Filho, Paulo R Lazarini, Leo F S Ditzel Filho, and Daniel M Prevedello.
• Department of Otolaryngology-Head & Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, U.S.A.
• Laryngoscope. 2015 Jun 1; 125 (6): 1284-90.

Objectives/HypothesisThis cadaveric study analyzes the endoscopic endonasal anatomy of the ophthalmic division of the trigeminal nerve (V1 ), from the middle fossa to its orbital entry via the superior orbital fissure. Anatomical relationships with the surrounding cranial nerves and blood vessels are described, with emphasis on their clinical correlation during surgery in this region. Our objective was to describe the anatomical relationships of the ophthalmic division of the trigeminal nerve.Study DesignCadaveric study.MethodsThirty middle cranial fossae, in adult human cadaveric specimens, were dissected endonasally under direct endoscopic visualization. During the dissection, we noted the relationships of the V1 nerve with the other trigeminal branches, as well as with the oculomotor and trochlear nerves, the paraclival and cavernous portions of the internal carotid artery, and the superior orbital fissure (SOF).ResultsThe V1 nerve is the most superior trigeminal branch and runs upward and obliquely, along the middle portion of the lateral wall of the cavernous sinus. The V1 nerve joins the oculomotor and trochlear nerves to exit the cavernous sinus and enter the orbit through the SOF. Ten percent of the specimens displayed the trochlear nerve running along as a mate of the V1 nerve. The V1 nerve borders two key triangles in the lateral wall of the cavernous sinus, and the Parkinson's and anteromedial triangles.ConclusionsIn this study, the V1 nerve was a constant and reliable landmark, thus allowing the identification of the anteromedial triangle. This potential space can serve as an adequate window to access the temporal lobe. Knowledge of this anatomy is essential when planning and executing endonasal surgery in this region.Level Of EvidenceNA.© 2014 The American Laryngological, Rhinological and Otological Society, Inc.

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