Mullan’s triangle or Anteromedial Triangle of the Middle Cranial Fossa: A Cadaveric Study with its Surgical Importance

Mullan’s triangle or Anteromedial Triangle of the Middle Cranial Fossa: A Cadaveric Study with its Surgical Importance | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Mullan’s triangle or Anteromedial Triangle of the Middle Cranial Fossa: A Cadaveric Study with its Surgical Importance Ariyanachi Kaliappan, Rohini Motwani, Mrudula Chandrupatla, Apurba Patra This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4790289/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 03 Sep, 2024 Read the published version in Surgical and Radiologic Anatomy → Version 1 posted 7 You are reading this latest preprint version Abstract Background Surgical approaches to the cavernous sinus (CS) and middle cranial fossa (MCF) can be challenging, particularly for young neurosurgeons. The anteromedial (Mullan’s) triangle is a triangle by the side of the CS and constitutes part of the floor of the MCF. The contents include the sphenoid sinus, superior ophthalmic vein, and sixth cranial nerve. The literature contains very little research that has precisely defined and measured the anteromedial triangle while considering anatomical variances minimally. Methodology : The present study was conducted on the skulls of 25 adult human cadavers which were dissected to expose the anteromedial (Mullan’s) triangle on both sides. After precisely defining the triangle on each side, measurements of the three borders were taken, and using Heron’s formula, the area of each triangle was calculated. Results On average, the length of the medial border was 12.5 (+ 3.1mm); the length of the lateral border was 9.9 (+ 3.1 mm); the length of the lateral border was 10.75 (+ 2.4 mm) and the area of the anteromedial triangle was 43.9 (+ 15.06 mm 2 ). Conclusion Precise anatomical knowledge of the Mullan’s triangle enables the treatment of disorders in often deformed anatomy or difficult-to-access structures. That is the reason it is important to gain a thorough understanding of the surgical anatomy and to adopt a safe procedure. Anteromedial triangle Cadaver Cavernous sinus Dimensions Mullan’s triangle Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction As a result of its complex anatomy and potential risk to patients, CS is referred to as a surgical "no-man's land." Dolenc and other pioneers' ground-breaking work signified a genuine revolution in surgical interest and understanding with reference to approaches to the CS[ 1 ].The skull base is a technically challenging region for neurosurgeons considering its location and important anatomical structures related to it. Around ten surgical triangles in the middle cranial fossa (MCF) close to the cavernous sinus (CS) have been described in the literature [Figure 1 ] [ 2 ]. The boundaries of these triangles are often marked by the cranial nerves II to VI, which are crucial anatomical landmarks for the neurosurgeons. In the mid-1960s, Parkinson was the first to discover the first intracranial triangle formed in the lateral wall of the CS by the trochlear and ophthalmic nerves to safely access the internal carotid artery lesion [ 3 ]. After then, a few anatomical and surgical investigations identified a number of triangles connected to the CS that are important for neurosurgeons. As they are based on constant anatomical landmarks, they serve as an intraoperatory pillar for localization of the CS and related structures. Anteromedial triangle (AMT), also referred to as Mullan’s triangle, as was first described by Mullan, in 1979 [ 4 ]. This triangle provides a limited corridor for visualising the final portion of the horizontal segment and the anterior bend of the internal carotid artery and sixth cranial nerve as it adopts a more inferolateral position towards ophthalmic nerve (V 1 ) and can be retracted medially for a greater amount of exposure [ 5 ]. AMT is also a corridor suited for exposing several other important structures, including the superior orbital vein, sphenoid sinus, and ophthalmic vein [ 6 ]. There are a very few studies in the literature that have clearly delineated and quantified the AMT. The AMT is bounded medially by posterior border of ophthalmic division (V 1 ) of trigeminal nerve (V), laterally by anterior border of maxillary nerve (V 2 ) and the base by a line connecting the superior orbital fissure to the foramen rotundum [4)]. Carotid-cavernous fistulas can be accessed with further dissection within Mullan's space. A little amount of temporal retraction is required in order to expose this triangle during endoscopic surgery using the supraorbital extradural technique[ 7 ] Generally, the superior orbital fissure artery passes through the lateral wall of the CS, supplying cranial nerves III, IV, VI, and ophthalmic nerve (V 1 ). The vascular supply of these nerves is therefore put at risk by procedures that alter the lateral wall of the CS at the anteromedial triangle, even if collaterals do exist[ 8 ].Therefore, a comprehensive understanding of the structure and variations of the AMT is crucial to skull-based surgery; this knowledge facilitates surgical planning and the appreciation of regional pathology. Only a few studies have examined and well-defined the boundaries of the AMT[ 9 ]. It is also essential to comprehend the AMT's dimensions in order to have a better understanding of the pathologic changes that exist inside and surrounding this region. Therefore, we anticipate that this study will aid neurosurgeons in their understanding of surgical approaches to the CS and MCF by providing with the additional information regarding the dimensions of the AMT of the (V 1 ). Materials and methods The present study was conducted on 25 donated adult human cadavers (13 females and 12 males) [ Table 1 ] , with age ranging from 75–80 years in the Department of Anatomy, All India Institute of Medical Sciences (AIIMS) Bibinagar, Hyderabad. Prior to their demise, all donors or their relatives gave their informed written consent, allowing their bodies to be employed in medical research and education. The Institutional Ethics Committee (ng routine dissection and practical teaching of undergraduate medical students, after careful removal of brain, duramater overlying the floor of the MCF was removed with utmost care in order to expose underlying structures. In order to do the morphometric study of triangles of MCF, we tried to preserve the trigeminal ganglion and its three divisions. Fine dissection was done to define the boundaries of the AMT on both the sides of the skull base in each of the 25 cadavers. The triangle was bounded medially by posterior border of the ophthalmic nerve (V 1 extending from its intersection with the medial margin of maxillary nerve to the lateral end of superior orbital fissure. The lateral boundary was formed by anterior border of the maxillary nerve, which was measured from its intersection with the mandibular nerve to the anterior most end of the foramen rotundum. The base of the triangle was formed by an imaginary line joining the lateral end of superior orbital fissure to foramen rotundum [ Figures 2 and 3 ]. Each border of the AMT was measured three times by one author; average of the three was taken as final measurement [ Table 3 ]. All the measurements were made by the same author to avoid subjective variation. Measurements were taken with the help of geometric divider, keeping its pointed ends on the ends of margins to be measured [ Figure 4 ]. Utmost care was taken to ensure that the exact distance between the pointed ends of the divider with which dimensions were measured on the specimen remain undisturbed while it was being transferred to the ruler for the measurements. With the help of Heron’s formula, area of each triangle was calculated (as mentioned below). The results were statistically analyzed for mean, range and standard deviation. The student’s t test was used to compare each parameter on the right and left side. Table 1 Showing sex distribution of the cadavers used for the present study. Sex Number of cadavers Number of anteromedial triangles traced Male 12 24 Female 13 26 Total 25 50 Table 2 Showing measurements of Anteromedial triangles of both the sides in human cadavers . Specimen Number Sides Medial border (mm) [along V1] Lateral border (mm) [along V2] Superior orbital fissure to foramen rotundum [Base] (mm) Area of the triangle (mm 2 ) 1 Right 18 17 9 75.63 Left 18 13 11 70.99 2 Right 9 10 8 34.20 Left 10 10 10 43.30 3 Right 15 8 11 42.89 Left 17 8 11 35.50 4 Right 11 6 9 26.98 Left 11 8 10 38.53 5 Right 10 8 11 38.53 Left 16 7 13 44.50 6 Right 14 9 7 26.83 Left 15 7 7 16.89 7 Right 15 9 13 58.16 Left 15 9 19 66.08 8 Right 16 8 13 51.68 Left 15 7 12 41.23 9 Right 14 7 8 18.79 Left 17 6 8 16.67 10 Right 10 7 11 34.29 Left 9 8 12 35.99 11 Right 10 16 11 54.3 Left 9.5 15 12 56.9 12 Right 11.5 14 7 40.08 Left 11 14.5 11 59.98 13 Right 8.5 8.5 10 34.37 Left 9.5 9.5 10.5 41.57 14 Right 9 13 11.5 50.55 Left 9 13 11 48.80 15 Right 10 11 13 53.44 Left 11 11.5 12.5 58.42 16 Right 15 5 16 37.47 Left 17 5 18 42.42 17 Right 18 12 13 77.95 Left 20 13 20 122.94 18 Right 15 5 17 36.21 Left 16 6 12 27.66 19 Right 17 7 20 57.45 Left 17 7 17 58.23 20 Right 21 13 18 116.27 Left 22 13 17 110.31 21 Right 20 12 21 117.20 Left 20 10 15 72.62 22 Right 12 5 9 20.40 Left 13 9 12 52.15 23 Right 23 12 13 56.28 Left 23 12 20 119.94 24 Right 25 16 21 167.03 Left 25 17 21 176.56 25 Right 15 7 20 42 Left 15 6 16 44.98 Mean ± SD (n = 30) 14.86 ± 4.51 9.8 ± 3.4 13.17 ± 4.16 57.44 ± 35.2 Range (mm) 8.5–25 5–17 7–21 16.67–176.56 Table 3 Comparison of measurements of the Anteromedial triangles between the right and left sides. SD: Standard Deviation, n: number of samples. In the 25 formalin fixed cadavers dissected, no statistically significant difference was observed in the measurements related to the boundaries of the Anteromedial triangles of the middle cranial fossa between the right and the left side ( P > 0.05). Side Mean ± SD (mm) (n = 30) Range (mm) P- value Medial border (along V1) Right 14.48 ± 4.5 8.5–25 0.55 Left 15.24 ± 4.5 9–25 Lateral border (along V2) Right 9.82 ± 3.6 5–17 0.96 Left 9.78 ± 3.3 5–17 Superior orbital fissure to foramen rotundum [base] Right 12.82 ± 4.4 7–21 0.55 Left 13.52 ± 3.9 7–21 Results The lengths of the medial border [along the ophthalmic nerve (V 1 )] ranged from 8.5 mm to 25 mm, with a mean length and standard deviation of 14.86 mm and 4.51 mm respectively. The lengths of the lateral border [along the maxillary nerve (V 2 )] ranged from 5 mm to 17 mm, with a mean length and standard deviation of 9.8 mm and 3.4 mm respectively. The lengths of the base (from lateral end of superior orbital fissure to foramen rotundum) ranged from 7 mm to 21 mm, with a mean length and standard deviation of 13.17 mm and 4.16 mm respectively. the area of the AMT observed was 57.44 ± 35.2 mm 2 [Table: 2]. In the 25 formalin fixed cadavers dissected, no statistically significant difference was observed in the measurements related to the boundaries of the AMT of the CS between the right and the left side ( p > 0.05) [Table: 3]. Discussion Endovascular and radiosurgery are becoming more and more popular in advanced brain surgery owing to great degree of safety and short recovery periods. It is crucial to have a thorough understanding of CS triangles. Even when CS lesions—whether malignant or vascular—distort the typical anatomy, identifying this distortion requires a foundational understanding of the normal architecture. The ability to accurately identify essential landmarks during the dissection of anatomical corridors in intracavernous aneurysms remains unaffected, despite the possibility of a high degree of anatomical distortion in certain cases of CS neoplasia. The surgeon also has to be aware that manipulating the cranial nerves might cause the triangles to expand. Regarding the authors' methodology, we are clarifying three points; two have to do with measurements, and one with nomenclature. To prevent bias, all measurements were taken by the same author. When all three sides of a triangle are known, the area may be easily calculated using the Heron's formula. The authors followed Rhoton's naming scheme when referring to the nomenclature of the triangle[ 10 ]. In the present study, the length of the medial border observed was 14.86 ( ± 4.51) mm; the length of the lateral border was 9.8 ( ± 3.4) mm; the length of the base was 13.17 ( ± 4.16) mm and the area of the AMT calculated was 57.44 ± 35.2mm 2 . To the best of our knowledge, no cadaveric studies have been done on the dimensions of AMT except by Watanabe et al ., and Isolan et al . [ 11 , 12 ] who measured the dimensions of AMT in 12 tissue blocks containing bilateral CS and 18 CS of five cadaveric heads and four skull bases respectively. To our knowledge, this is the first Indian study aimed at defining the measurements of the AMT. In the study done by Watanabe et al ., the mean length of the medial border [along ophthalmic nerve (V 1 )], lateral border [along maxillary nerve (V 2 )] and base are 7.8 mm, 5.83 mm and 12.0 mm respectively with the lateral border being the longest and the shortest border along the maxillary nerve [ 11 ]. This contradicts our findings where the longest border of the triangle extends along the ophthalmic nerve (V 1 ). Isolan etal ., documented the mean length of the medial [along ophthalmic nerve [V 1 )], lateral border [along maxillary nerve [V 2 )] and base as 10.18 ± 0.62 mm, 7.87 ± 0.29 mm and 9.96 ± 1.13 mm and respectively and the area of the triangle is 36.26 ± 3.75, the findings of whom are almost similar to our study with the ophthalmic nerve (V 1 ) located along the lengthier side of the triangle [ 12 ]. The comparison table for the morphometry of ALT is given in Table 4 . Table 4 Comparison of the morphometry of Anteromedial triangle of present study with similar other studies. S.No Authors Number of specimens Observations 1 Watanabe et al ., [ 11 ] 12 Japanese cadaveric heads (24 cavernous sinus) Medial border (along V1): 7.8 mm Lateral border (along V2): 5.83 mm Base (from SOF to foramen rotundum): 12 mm 2 Isolen et al .,[ 12 ] 9 cadaveric heads (18 cavernous sinus) and 4 skull bases Medial border (along V1): 10.18 ± 0.62 mm Lateral border (along V2): 7.87 ± 0.29 mm Base (from SOF to foramen rotundum): 11.59 ± 1.61 mm 3 Present study 25 adult cadaveric heads (50 cavernous sinus) Medial border (along V1): 14.86 ± 4.51 mm Lateral border (along V2): 9.8 ± 3.4 mm Base (from SOF to foramen rotundum): 13.17 ± 4.16 mm Area: 57.44 ± 35.2 mm 2 We hypothesize that the base of these measurement variations may be varying degrees of dissection of the ophthalmic and maxillary nerves as well as the force applied when retracting the duramater over the MCF. In the future, the cadaveric results should be coupled with the radiological data to enable efficient identification of appropriate surgical approaches to the MCF across this key corridor, therefore overriding the subjective variances that will inevitably arise during the dissection. The AMT provides a narrow corridor that allows visualization of the final portion of the horizontal segment and the anterior bend of the cavernous part of internal carotid artery and sixth cranial nerve as it assumes a more inferolateral position towards ophthalmic nerve that can be medially retracted for better exposure [ 1 ]. Additionally, by drilling the bone between the foramen rotundum and the superior orbital fissure, the sphenoid sinus is left accessible [ 8 ]. Limitations Studies suggest that 10–15% of tissue shrinkage is caused by formalin, which may conceal the original dimensions[ 13 ]. However, according to another study conducted on breast cancer specimens, there was no discernible difference between the fresh and fixed specimens in 96% of the cases[ 14 ]. Conclusion Because the CS triangles are natural passageways that allow lesions inside the CS to be accessed, their normal anatomy and size are significant for approaches to CS lesions.In endoscopic endonasal procedures, the triangle is an essential window for accessing MCF structures. Understanding these anatomical corridors and their corresponding sizes is essential for identifying the lesions and preventing damage to the neurological and vascular structures. We hope that our findings will deepen the comprehension of this crucial surgical triangle and related structures in anatomy education, radiology and surgical training. Declarations Ethics approval and consent to participate: This is a cadaveric study that is completely done on donated cadavers, used for teaching and research purpose. All donors or their relatives provided informed written consent prior to their death so that their bodies can be utilized for medical education and research. As the study was conducted on donated cadavers, exemption from review was taken from Institutional Ethics Committee (IEC). Consent for publication: All the authors gave consent for the publication of the report. Availability of data and materials: Data and material related to the report will be available with the corresponding author for further reference. Financial support: Nil. Conflicts of interest: There are no conflicts of interest to declare. Author Contributions : Conceptualization: AK, RM, MC; Data acquisition: AK, RM, MC, AP; Data analysis or interpretation: AK, RM, MC. Drafting of the manuscript: AK, RM, MC. Critical revision of the manuscript: AK, RM, MC, AP. Approval of the final version of the manuscript: all authors. Acknowledgement: We would like to thank the donors and their families for agreeing to donate the bodies of their loved ones for medical education and research purposes. We are grateful to the dissection hall attenders in our department for their technical assistance. References Dolenc V (1989) Anatomy and Surgery of the Cavernous Sinus, 1st edn. Springer-, Vienna, Austria, pp 3–137 Rhoton AL (2002) The cavernous sinus, the cavernous venous plexus, and the carotid collar. Neurosurgery 51(4):S375–410. https://pubmed.ncbi.nlm.nih.gov/12234454/ Parkinson D (1965) A surgical approach to the cavernous portion of the carotid artery. Anatomical studies and case report. J Neurosurg 23(5):474–483 Mullan S (1979) Treatment of carotid-cavernous fistulas by cavernous sinus occlusion. J Neurosurg 50(2):131–144 Dolenc VV (1985) A combined epi- and subdural direct approach to carotid-ophthalmic artery aneurysms. J Neurosurg 62(5):667–672 Conti M, Prevedello DM, Madhok R, Faure A, Ricci UM, Schwarz A et al (2008) The antero-medial triangle: the risk for cranial nerves ischemia at the cavernous sinus lateral wall. Anatomic cadaveric study. Clin Neurol Neurosurg 110(7):682–686 Komatsu F, Komatsu M, Inoue T, Tschabitscher M (2011) Endoscopic supraorbital extradural approach to the cavernous sinus: a cadaver study. J Neurosurg 114(5):1331–1337 Dalgiç A, Boyaci S, Aksoy K (2010) Anatomical study of the cavernous sinus emphasizing operative approaches. Turk Neurosurg 20(2):186–204 Stempniewicz M, Sloniewski P, Smida K, Rynkowski M, Zielinski P (2001) The microsurgical anatomy of the anteromedial triangle of the cavernous sinus. Res gate 1:11 Rhoton A (2002) The Supratentorial Cranial Space: Microsurgical Anatomy and Surgical Approaches. Neurosurgery 51:S1–iii Watanabe A, Nagaseki Y, Ohkubo S, Ohhashi Y, Horikoshi T, Nishigaya K et al (2003) Anatomical variations of the ten triangles around the cavernous sinus. Clin Anat N Y N 16(1):9–14 Isolan GR, Krayenbühl N, de Oliveira E, Al-Mefty O (2007) Microsurgical Anatomy of the Cavernous Sinus: Measurements of the Triangles in and around It. Skull Base 17(6):357–367 Siu KF, Cheung HC, Wong J (1986) Shrinkage of the esophagus after resection for carcinoma. Ann Surg 203(2):173–176 Pritt B, Tessitore JJ, Weaver DL, Blaszyk H (2005) The effect of tissue fixation and processing on breast cancer size. Hum Pathol 36(7):756–760 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 03 Sep, 2024 Read the published version in Surgical and Radiologic Anatomy → Version 1 posted Editorial decision: Revision requested 14 Aug, 2024 Reviews received at journal 03 Aug, 2024 Reviewers agreed at journal 28 Jul, 2024 Reviewers invited by journal 24 Jul, 2024 Editor assigned by journal 24 Jul, 2024 Submission checks completed at journal 24 Jul, 2024 First submitted to journal 23 Jul, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4790289","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":340224036,"identity":"c1358773-4f49-47cf-b5e6-1a0b9efa361d","order_by":0,"name":"Ariyanachi Kaliappan","email":"","orcid":"","institution":"All India Institute of Medical Sciences Bibinagar, Hyderabad","correspondingAuthor":false,"prefix":"","firstName":"Ariyanachi","middleName":"","lastName":"Kaliappan","suffix":""},{"id":340224038,"identity":"690ab075-98f7-4f4a-9cb2-e74c1bb5419a","order_by":1,"name":"Rohini Motwani","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4ElEQVRIiWNgGAWjYFACHoYDDAZQdkIFkGBmbiBOCw9YyxmQFkbCWhAUYxuYxK/FvL334OGCgm1y9hLJzx48nFcbzd8O1PKjYhtOLTJnziUcnmFw25hHIs3cIHHb8dwZhxkbGHvO3MapRUIix+Awj8HtxB7pBDOJxG3HchuAWpgZ24jSkv5NInHOsdz5JGjJAdrSUJO7gaAWnjNgLcY899+USSQcO5C7EajlIF6/sPcYf+b5c1uOvef4NskfNXW5884fPvjgRwVuLejgMJg8QLR6IKgjRfEoGAWjYBSMEAAAyOZZ/54+AtQAAAAASUVORK5CYII=","orcid":"","institution":"All India Institute of Medical Sciences Bibinagar, Hyderabad","correspondingAuthor":true,"prefix":"","firstName":"Rohini","middleName":"","lastName":"Motwani","suffix":""},{"id":340224039,"identity":"d079ac6a-e946-427c-807a-89e42768514b","order_by":2,"name":"Mrudula Chandrupatla","email":"","orcid":"","institution":"All India Institute of Medical Sciences Bibinagar, Hyderabad","correspondingAuthor":false,"prefix":"","firstName":"Mrudula","middleName":"","lastName":"Chandrupatla","suffix":""},{"id":340224040,"identity":"069f04f3-89a6-45d4-aba9-ca0ca9db4d72","order_by":3,"name":"Apurba Patra","email":"","orcid":"","institution":"All India Institute of Medical Sciences (AIIMS) Bathinda (Punjab)","correspondingAuthor":false,"prefix":"","firstName":"Apurba","middleName":"","lastName":"Patra","suffix":""}],"badges":[],"createdAt":"2024-07-23 16:29:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4790289/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4790289/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00276-024-03475-x","type":"published","date":"2024-09-03T15:57:30+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":63312666,"identity":"afc3621d-6531-45f4-9b5f-e40e2b43b68c","added_by":"auto","created_at":"2024-08-26 20:43:37","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":118790,"visible":true,"origin":"","legend":"\u003cp\u003eShowing classification of the ten neurosurgical triangles of the middle cranial fossa and the cavernous sinus [2].\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4790289/v1/9be612bb6033c54990ff4635.jpeg"},{"id":63312668,"identity":"7904995f-f4e2-4364-b419-9afa099dba92","added_by":"auto","created_at":"2024-08-26 20:43:37","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":228290,"visible":true,"origin":"","legend":"\u003cp\u003eMiddle cranial fossa (MCF) of right side- superolateral view, showing Right Antero-Medial Triangle (RAMT) bounded by the ophthalmic division (\u003cstrong\u003ea-V\u003c/strong\u003e\u003csub\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/sub\u003e) of the trigeminal (V) nerve medially and the maxillary division (\u003cstrong\u003eb-V\u003c/strong\u003e\u003csub\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/sub\u003e) of the trigeminal (V) nerve laterally. The triangle base consists of the anterolateral wall of the bony middle cranial fossa (MCF) formed by an imaginary line (‘\u003cstrong\u003ec\u003c/strong\u003e’) connecting the Superior orbital fissure (SOF) to the foramen rotundum (FR). V\u003csub\u003e3\u003c/sub\u003e: Mandibular division of V nerve, ICA1: Internal carotid artery in cavernous sinus (Cavernous part), ICA2:\u0026nbsp; Para clinoidal of Internal carotid artery (Cut end), ACP: Anterior Clinoid Process, FO: Foramen Ovale, ON: Optic Nerve, PTB: Petrous Temporal Bone, TG: Trigeminal Ganglion.\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4790289/v1/b4dd606229d1e8a6f42c41f9.jpeg"},{"id":63312670,"identity":"7c6cd6e9-aa52-42b4-a184-c556510d5647","added_by":"auto","created_at":"2024-08-26 20:43:37","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":668836,"visible":true,"origin":"","legend":"\u003cp\u003eMiddle cranial fossa (MCF) of left side- superolateral view, showing Left Antero-Medial Triangle (LAMT), bounded medially by ‘\u003cstrong\u003ea’\u003c/strong\u003e \u003cstrong\u003e(V\u003c/strong\u003e\u003csub\u003e1\u003c/sub\u003e): Ophthalmic nerve, laterally by ‘\u003cstrong\u003eb’ (V\u003c/strong\u003e\u003csub\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/sub\u003e\u003cstrong\u003e):\u003c/strong\u003e Maxillary nerve, \u003cstrong\u003e‘c’\u003c/strong\u003e forms the base of the triangle. CS: Cavernous sinus, TG: Trigeminal Ganglion, MMA: Middle meningeal artery (cut end), SOF: Superior Orbital Fissure, FO: Foramen Ovale, FR: Foramen Rotundum.\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4790289/v1/7fc35c9458ed8663c1d5d387.jpeg"},{"id":63313299,"identity":"d362bd61-92e7-4a03-9ee5-37be66e1371e","added_by":"auto","created_at":"2024-08-26 20:51:37","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":555527,"visible":true,"origin":"","legend":"\u003cp\u003eMethod used for measuring the boundaries of Anteromedial triangle of Middle Cranial Fossa, using geometric divider, keeping its pointed ends on the ends of margins to be measured.\u003c/p\u003e","description":"","filename":"floatimage5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4790289/v1/22be552f9a25d3164515849b.jpeg"},{"id":63312667,"identity":"da0b330c-4509-41df-a494-3ef6dae4da29","added_by":"auto","created_at":"2024-08-26 20:43:37","extension":"jpeg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":133434,"visible":true,"origin":"","legend":"\u003cp\u003eUnnumbered image in the Materials \u0026amp; Methods section.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4790289/v1/745ec7d18433a58990376ae5.jpeg"},{"id":64185848,"identity":"e4606973-0d31-48c0-b645-acddec962312","added_by":"auto","created_at":"2024-09-09 16:22:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2428685,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4790289/v1/982ea3a0-e36d-411e-98ab-afe86bcea0ef.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Mullan’s triangle or Anteromedial Triangle of the Middle Cranial Fossa: A Cadaveric Study with its Surgical Importance","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAs a result of its complex anatomy and potential risk to patients, CS is referred to as a surgical \"no-man's land.\" Dolenc and other pioneers' ground-breaking work signified a genuine revolution in surgical interest and understanding with reference to approaches to the CS[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].The skull base is a technically challenging region for neurosurgeons considering its location and important anatomical structures related to it. Around ten surgical triangles in the middle cranial fossa (MCF) close to the cavernous sinus (CS) have been described in the literature [Figure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e] [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The boundaries of these triangles are often marked by the cranial nerves II to VI, which are crucial anatomical landmarks for the neurosurgeons. In the mid-1960s, Parkinson was the first to discover the first intracranial triangle formed in the lateral wall of the CS by the trochlear and ophthalmic nerves to safely access the internal carotid artery lesion [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. After then, a few anatomical and surgical investigations identified a number of triangles connected to the CS that are important for neurosurgeons. As they are based on constant anatomical landmarks, they serve as an intraoperatory pillar for localization of the CS and related structures.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAnteromedial triangle (AMT), also referred to as Mullan\u0026rsquo;s triangle, as was first described by Mullan, in 1979 [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This triangle provides a limited corridor for visualising the final portion of the horizontal segment and the anterior bend of the internal carotid artery and sixth cranial nerve as it adopts a more inferolateral position towards ophthalmic nerve (V\u003csub\u003e1\u003c/sub\u003e) and can be retracted medially for a greater amount of exposure [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. AMT is also a corridor suited for exposing several other important structures, including the superior orbital vein, sphenoid sinus, and ophthalmic vein [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. There are a very few studies in the literature that have clearly delineated and quantified the AMT. The AMT is bounded medially by posterior border of ophthalmic division (V\u003csub\u003e1\u003c/sub\u003e) of trigeminal nerve (V), laterally by anterior border of maxillary nerve (V\u003csub\u003e2\u003c/sub\u003e) and the base by a line connecting the superior orbital fissure to the foramen rotundum [4)]. Carotid-cavernous fistulas can be accessed with further dissection within Mullan's space. A little amount of temporal retraction is required in order to expose this triangle during endoscopic surgery using the supraorbital extradural technique[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] Generally, the superior orbital fissure artery passes through the lateral wall of the CS, supplying cranial nerves III, IV, VI, and ophthalmic nerve (V\u003csub\u003e1\u003c/sub\u003e). The vascular supply of these nerves is therefore put at risk by procedures that alter the lateral wall of the CS at the anteromedial triangle, even if collaterals do exist[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].Therefore, a comprehensive understanding of the structure and variations of the AMT is crucial to skull-based surgery; this knowledge facilitates surgical planning and the appreciation of regional pathology. Only a few studies have examined and well-defined the boundaries of the AMT[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. It is also essential to comprehend the AMT's dimensions in order to have a better understanding of the pathologic changes that exist inside and surrounding this region. Therefore, we anticipate that this study will aid neurosurgeons in their understanding of surgical approaches to the CS and MCF by providing with the additional information regarding the dimensions of the AMT of the (V\u003csub\u003e1\u003c/sub\u003e).\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eThe present study was conducted on 25 donated adult human cadavers (13 females and 12 males) \u003cb\u003e[\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e]\u003c/b\u003e, with age ranging from 75\u0026ndash;80 years in the Department of Anatomy, All India Institute of Medical Sciences (AIIMS) Bibinagar, Hyderabad. Prior to their demise, all donors or their relatives gave their informed written consent, allowing their bodies to be employed in medical research and education. The Institutional Ethics Committee (ng routine dissection and practical teaching of undergraduate medical students, after careful removal of brain, duramater overlying the floor of the MCF was removed with utmost care in order to expose underlying structures. In order to do the morphometric study of triangles of MCF, we tried to preserve the trigeminal ganglion and its three divisions. Fine dissection was done to define the boundaries of the AMT on both the sides of the skull base in each of the 25 cadavers. The triangle was bounded medially by posterior border of the ophthalmic nerve (V\u003csub\u003e1\u003c/sub\u003eextending from its intersection with the medial margin of maxillary nerve to the lateral end of superior orbital fissure. The lateral boundary was formed by anterior border of the maxillary nerve, which was measured from its intersection with the mandibular nerve to the anterior most end of the foramen rotundum. The base of the triangle was formed by an imaginary line joining the lateral end of superior orbital fissure to foramen rotundum \u003cb\u003e[\u003c/b\u003eFigures \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e].\u003c/b\u003e Each border of the AMT was measured three times by one author; average of the three was taken as final measurement \u003cb\u003e[\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e].\u003c/b\u003e All the measurements were made by the same author to avoid subjective variation. Measurements were taken with the help of geometric divider, keeping its pointed ends on the ends of margins to be measured \u003cb\u003e[\u003c/b\u003eFigure \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cb\u003e].\u003c/b\u003e Utmost care was taken to ensure that the exact distance between the pointed ends of the divider with which dimensions were measured on the specimen remain undisturbed while it was being transferred to the ruler for the measurements. With the help of Heron\u0026rsquo;s formula, area of each triangle was calculated (as mentioned below). The results were statistically analyzed for mean, range and standard deviation. The student\u0026rsquo;s t test was used to compare each parameter on the right and left side.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eShowing sex distribution of the cadavers used for the present study.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of cadavers\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of anteromedial triangles traced\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eShowing measurements of Anteromedial triangles of both the sides in human cadavers .\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpecimen Number\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSides\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedial border (mm) [along V1]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLateral border (mm) [along V2]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSuperior orbital fissure to foramen rotundum [Base] (mm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eArea of the triangle (mm\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e75.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e70.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e43.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e42.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e35.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e38.53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e38.53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e44.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e58.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e66.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e51.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e41.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e35.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e54.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e56.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e59.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34.37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e41.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e50.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e48.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e53.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e58.42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e37.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e42.42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e77.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e122.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e36.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e27.66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e57.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e58.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e116.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e110.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e117.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e72.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e52.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e56.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e119.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e167.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e176.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e44.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMean\u003c/b\u003e\u0026thinsp;\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;\u003cb\u003eSD\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(n\u0026thinsp;=\u0026thinsp;30)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.86\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;4.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.8\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.17\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;4.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e57.44\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;35.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eRange (mm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.5\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7\u0026ndash;21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16.67\u0026ndash;176.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of measurements of the Anteromedial triangles between the right and left sides. SD: Standard Deviation, n: number of samples. In the 25 formalin fixed cadavers dissected, no statistically significant difference was observed in the measurements related to the boundaries of the Anteromedial triangles of the middle cranial fossa between the right and the left side (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSide\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;SD (mm)\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRange (mm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP-\u003c/em\u003evalue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eMedial border (along V1)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e14.48\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.5\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e15.24\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eLateral border (along V2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.82\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;3.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.78\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eSuperior orbital fissure to foramen rotundum [base]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e12.82\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;4.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u0026ndash;21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e13.52\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u0026ndash;21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe lengths of the medial border [along the ophthalmic nerve (V\u003csub\u003e1\u003c/sub\u003e)] ranged from 8.5 mm to 25 mm, with a mean length and standard deviation of 14.86 mm and 4.51 mm respectively. The lengths of the lateral border [along the maxillary nerve (V\u003csub\u003e2\u003c/sub\u003e)] ranged from 5 mm to 17 mm, with a mean length and standard deviation of 9.8 mm and 3.4 mm respectively. The lengths of the base (from lateral end of superior orbital fissure to foramen rotundum) ranged from 7 mm to 21 mm, with a mean length and standard deviation of 13.17 mm and 4.16 mm respectively. the area of the AMT observed was 57.44\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;35.2 mm\u003csup\u003e2\u003c/sup\u003e\u003cb\u003e[Table: 2].\u003c/b\u003e In the 25 formalin fixed cadavers dissected, no statistically significant difference was observed in the measurements related to the boundaries of the AMT of the CS between the right and the left side (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) \u003cb\u003e[Table: 3].\u003c/b\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eEndovascular and radiosurgery are becoming more and more popular in advanced brain surgery owing to great degree of safety and short recovery periods. It is crucial to have a thorough understanding of CS triangles. Even when CS lesions\u0026mdash;whether malignant or vascular\u0026mdash;distort the typical anatomy, identifying this distortion requires a foundational understanding of the normal architecture. The ability to accurately identify essential landmarks during the dissection of anatomical corridors in intracavernous aneurysms remains unaffected, despite the possibility of a high degree of anatomical distortion in certain cases of CS neoplasia. The surgeon also has to be aware that manipulating the cranial nerves might cause the triangles to expand. Regarding the authors' methodology, we are clarifying three points; two have to do with measurements, and one with nomenclature. To prevent bias, all measurements were taken by the same author. When all three sides of a triangle are known, the area may be easily calculated using the Heron's formula. The authors followed Rhoton's naming scheme when referring to the nomenclature of the triangle[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the present study, the length of the medial border observed was 14.86 (\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;4.51) mm; the length of the lateral border was 9.8 (\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;3.4) mm; the length of the base was 13.17 (\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;4.16) mm and the area of the AMT calculated was 57.44\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;35.2mm\u003csup\u003e2\u003c/sup\u003e. To the best of our knowledge, no cadaveric studies have been done on the dimensions of AMT except by Watanabe \u003cem\u003eet al\u003c/em\u003e., and Isolan \u003cem\u003eet al\u003c/em\u003e. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] who measured the dimensions of AMT in 12 tissue blocks containing bilateral CS and 18 CS of five cadaveric heads and four skull bases respectively. To our knowledge, this is the first Indian study aimed at defining the measurements of the AMT.\u003c/p\u003e \u003cp\u003eIn the study done by Watanabe \u003cem\u003eet al\u003c/em\u003e., the mean length of the medial border [along ophthalmic nerve (V\u003csub\u003e1\u003c/sub\u003e)], lateral border [along maxillary nerve (V\u003csub\u003e2\u003c/sub\u003e)] and base are 7.8 mm, 5.83 mm and 12.0 mm respectively with the lateral border being the longest and the shortest border along the maxillary nerve [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This contradicts our findings where the longest border of the triangle extends along the ophthalmic nerve (V\u003csub\u003e1\u003c/sub\u003e). Isolan\u003cem\u003eetal\u003c/em\u003e., documented the mean length of the medial [along ophthalmic nerve [V\u003csub\u003e1\u003c/sub\u003e)], lateral border [along maxillary nerve [V\u003csub\u003e2\u003c/sub\u003e)] and base as 10.18\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62 mm, 7.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.29 mm and 9.96\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13 mm and respectively and the area of the triangle is 36.26\u0026thinsp;\u0026plusmn;\u0026thinsp;3.75, the findings of whom are almost similar to our study with the ophthalmic nerve (V\u003csub\u003e1\u003c/sub\u003e) located along the lengthier side of the triangle [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The comparison table for the morphometry of ALT is given in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of the morphometry of Anteromedial triangle of present study with similar other studies.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS.No\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAuthors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of specimens\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eObservations\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWatanabe \u003cem\u003eet al\u003c/em\u003e., [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 Japanese cadaveric heads (24 cavernous sinus)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMedial border (along V1): 7.8 mm\u003c/p\u003e \u003cp\u003eLateral border (along V2): 5.83 mm\u003c/p\u003e \u003cp\u003eBase (from SOF to foramen rotundum): 12 mm\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIsolen \u003cem\u003eet al\u003c/em\u003e.,[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 cadaveric heads (18 cavernous sinus) and 4 skull bases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMedial border (along V1): 10.18\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62 mm\u003c/p\u003e \u003cp\u003eLateral border (along V2): 7.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.29 mm\u003c/p\u003e \u003cp\u003eBase (from SOF to foramen rotundum): 11.59\u0026thinsp;\u0026plusmn;\u0026thinsp;1.61 mm\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePresent study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 adult cadaveric heads (50 cavernous sinus)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMedial border (along V1): 14.86\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;4.51 mm\u003c/p\u003e \u003cp\u003eLateral border (along V2): 9.8\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;3.4 mm\u003c/p\u003e \u003cp\u003eBase (from SOF to foramen rotundum): 13.17\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;4.16 mm\u003c/p\u003e \u003cp\u003eArea: 57.44\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;35.2 mm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWe hypothesize that the base of these measurement variations may be varying degrees of dissection of the ophthalmic and maxillary nerves as well as the force applied when retracting the duramater over the MCF. In the future, the cadaveric results should be coupled with the radiological data to enable efficient identification of appropriate surgical approaches to the MCF across this key corridor, therefore overriding the subjective variances that will inevitably arise during the dissection. The AMT provides a narrow corridor that allows visualization of the final portion of the horizontal segment and the anterior bend of the cavernous part of internal carotid artery and sixth cranial nerve as it assumes a more inferolateral position towards ophthalmic nerve that can be medially retracted for better exposure [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Additionally, by drilling the bone between the foramen rotundum and the superior orbital fissure, the sphenoid sinus is left accessible [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eStudies suggest that 10\u0026ndash;15% of tissue shrinkage is caused by formalin, which may conceal the original dimensions[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. However, according to another study conducted on breast cancer specimens, there was no discernible difference between the fresh and fixed specimens in 96% of the cases[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBecause the CS triangles are natural passageways that allow lesions inside the CS to be accessed, their normal anatomy and size are significant for approaches to CS lesions.In endoscopic endonasal procedures, the triangle is an essential window for accessing MCF structures. Understanding these anatomical corridors and their corresponding sizes is essential for identifying the lesions and preventing damage to the neurological and vascular structures. We hope that our findings will deepen the comprehension of this crucial surgical triangle and related structures in anatomy education, radiology and surgical training.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eThis is a cadaveric study that is completely done on donated cadavers, used for teaching and research purpose.\u0026nbsp;All donors or their relatives provided informed written consent prior to their death so that their bodies can be utilized for medical education and research. As the study was conducted on donated cadavers, exemption from review was taken from Institutional Ethics Committee (IEC).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eAll the authors gave consent for the publication of the report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e Data and material related to the report will be\u003c/p\u003e\n\u003cp\u003eavailable with the corresponding author for further reference.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinancial support:\u003c/strong\u003e Nil.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest:\u003c/strong\u003e There are no conflicts of interest to declare.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e:\u0026nbsp;Conceptualization: AK, RM, MC; Data acquisition: AK, RM, MC, AP; Data analysis or interpretation: AK, RM, MC. Drafting of the manuscript: AK, RM, MC. Critical revision of the manuscript: AK, RM, MC, AP. Approval of the final version of the manuscript: all authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement:\u0026nbsp;\u003c/strong\u003eWe would like to thank the donors and their families for agreeing to donate the bodies of their loved ones for medical education and research purposes. We are grateful to the dissection hall attenders in our department for their technical assistance.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDolenc V (1989) Anatomy and Surgery of the Cavernous Sinus, 1st edn. Springer-, Vienna, Austria, pp 3\u0026ndash;137\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRhoton AL (2002) The cavernous sinus, the cavernous venous plexus, and the carotid collar. Neurosurgery 51(4):S375\u0026ndash;410. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/12234454/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/12234454/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eParkinson D (1965) A surgical approach to the cavernous portion of the carotid artery. Anatomical studies and case report. J Neurosurg 23(5):474\u0026ndash;483\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMullan S (1979) Treatment of carotid-cavernous fistulas by cavernous sinus occlusion. J Neurosurg 50(2):131\u0026ndash;144\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDolenc VV (1985) A combined epi- and subdural direct approach to carotid-ophthalmic artery aneurysms. J Neurosurg 62(5):667\u0026ndash;672\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eConti M, Prevedello DM, Madhok R, Faure A, Ricci UM, Schwarz A et al (2008) The antero-medial triangle: the risk for cranial nerves ischemia at the cavernous sinus lateral wall. Anatomic cadaveric study. Clin Neurol Neurosurg 110(7):682\u0026ndash;686\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKomatsu F, Komatsu M, Inoue T, Tschabitscher M (2011) Endoscopic supraorbital extradural approach to the cavernous sinus: a cadaver study. J Neurosurg 114(5):1331\u0026ndash;1337\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDalgi\u0026ccedil; A, Boyaci S, Aksoy K (2010) Anatomical study of the cavernous sinus emphasizing operative approaches. Turk Neurosurg 20(2):186\u0026ndash;204\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStempniewicz M, Sloniewski P, Smida K, Rynkowski M, Zielinski P (2001) The microsurgical anatomy of the anteromedial triangle of the cavernous sinus. Res gate 1:11\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRhoton A (2002) The Supratentorial Cranial Space: Microsurgical Anatomy and Surgical Approaches. Neurosurgery 51:S1\u0026ndash;iii\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWatanabe A, Nagaseki Y, Ohkubo S, Ohhashi Y, Horikoshi T, Nishigaya K et al (2003) Anatomical variations of the ten triangles around the cavernous sinus. Clin Anat N Y N 16(1):9\u0026ndash;14\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIsolan GR, Krayenb\u0026uuml;hl N, de Oliveira E, Al-Mefty O (2007) Microsurgical Anatomy of the Cavernous Sinus: Measurements of the Triangles in and around It. Skull Base 17(6):357\u0026ndash;367\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSiu KF, Cheung HC, Wong J (1986) Shrinkage of the esophagus after resection for carcinoma. Ann Surg 203(2):173\u0026ndash;176\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePritt B, Tessitore JJ, Weaver DL, Blaszyk H (2005) The effect of tissue fixation and processing on breast cancer size. Hum Pathol 36(7):756\u0026ndash;760\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"surgical-and-radiologic-anatomy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sara","sideBox":"Learn more about [Surgical and Radiologic Anatomy](http://link.springer.com/journal/276)","snPcode":"276","submissionUrl":"https://submission.nature.com/new-submission/276/3","title":"Surgical and Radiologic Anatomy","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Anteromedial triangle, Cadaver, Cavernous sinus, Dimensions, Mullan’s triangle","lastPublishedDoi":"10.21203/rs.3.rs-4790289/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4790289/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSurgical approaches to the cavernous sinus (CS) and middle cranial fossa (MCF) can be challenging, particularly for young neurosurgeons. The anteromedial (Mullan’s) triangle is a triangle by the side of the CS and constitutes part of the floor of the MCF. The contents include the sphenoid sinus, superior ophthalmic vein, and sixth cranial nerve. The literature contains very little research that has precisely defined and measured the anteromedial triangle while considering anatomical variances minimally.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eThe present study was conducted on the skulls of 25 adult human cadavers which were dissected to expose the anteromedial (Mullan’s) triangle on both sides. After precisely defining the triangle on each side, measurements of the three borders were taken, and using Heron’s formula, the area of each triangle was calculated.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOn average, the length of the medial border was 12.5 (+ 3.1mm); the length of the lateral border was 9.9 (+ 3.1 mm); the length of the lateral border was 10.75 (+ 2.4 mm) and the area of the anteromedial triangle was 43.9 (+ 15.06 mm\u003csup\u003e2\u003c/sup\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrecise anatomical knowledge of the Mullan’s triangle enables the treatment of disorders in often deformed anatomy or difficult-to-access structures. That is the reason it is important to gain a thorough understanding of the surgical anatomy and to adopt a safe procedure.\u003c/p\u003e","manuscriptTitle":"Mullan’s triangle or Anteromedial Triangle of the Middle Cranial Fossa: A Cadaveric Study with its Surgical Importance","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-26 20:43:32","doi":"10.21203/rs.3.rs-4790289/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-08-14T11:59:47+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-03T20:36:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"12551407815853105946844541745509826880","date":"2024-07-28T11:19:04+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-24T20:19:29+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-24T20:13:31+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-24T13:54:50+00:00","index":"","fulltext":""},{"type":"submitted","content":"Surgical and Radiologic Anatomy","date":"2024-07-23T16:26:41+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"surgical-and-radiologic-anatomy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sara","sideBox":"Learn more about [Surgical and Radiologic Anatomy](http://link.springer.com/journal/276)","snPcode":"276","submissionUrl":"https://submission.nature.com/new-submission/276/3","title":"Surgical and Radiologic Anatomy","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"1c3f3b9b-8f63-48bb-be27-805979bc4517","owner":[],"postedDate":"August 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-09-09T16:13:12+00:00","versionOfRecord":{"articleIdentity":"rs-4790289","link":"https://doi.org/10.1007/s00276-024-03475-x","journal":{"identity":"surgical-and-radiologic-anatomy","isVorOnly":false,"title":"Surgical and Radiologic Anatomy"},"publishedOn":"2024-09-03 15:57:30","publishedOnDateReadable":"September 3rd, 2024"},"versionCreatedAt":"2024-08-26 20:43:32","video":"","vorDoi":"10.1007/s00276-024-03475-x","vorDoiUrl":"https://doi.org/10.1007/s00276-024-03475-x","workflowStages":[]},"version":"v1","identity":"rs-4790289","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4790289","identity":"rs-4790289","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}