Microsurgical anatomy of the sellar region

1975 ◽  
Vol 43 (3) ◽  
pp. 288-298 ◽  
Author(s):  
Wade H. Renn ◽  
Albert L. Rhoton
Keyword(s):  
Sphenoid Sinus ◽  
Carotid Arteries ◽  
Sella Turcica ◽  
Acute Angle ◽  
Surgical Approaches ◽  
Microsurgical Anatomy ◽  
Optic Nerves ◽  
Content Type ◽  
Sellar Floor ◽  
Fine Print

✓ Fifty adult sellae and surrounding structures were examined under magnification with special attention given to anatomical variants important to the transfrontal and transsphenoidal surgical approaches. The discovered variants considered disadvantageous to the transsphenoidal approach were as follows: 1) large anterior intercavernous sinuses extending anterior to the gland just posterior to the anterior sellar wall in 10%; 2) a thin diaphragm in 62%, or a diaphragm with a large opening in 56%; 3) carotid arteries exposed in the sphenoid sinus with no bone over them in 4%; 4) carotid arteries that approach within 4 mm of midline within the sella in 10%; 5) optic canals with bone defects exposing the optic nerves in the sphenoid sinus in 4%; 6) a thick sellar floor in 18%; 7) sphenoid sinuses with no major septum in 28% or a sinus with the major septum well off midline in 47%; and 8) a presellar type of sphenoid sinus with no obvious bulge of the sellar floor into the sphenoid sinus in 20%. Variants considered disadvantageous to the transfrontal approach were found as follows: 1) a prefixed chiasm in 10% and a normal chiasm with 2 mm or less between the chiasm and tuberculum sellae in 14%; 2) an acute angle between the optic nerves as they entered the chiasm in 25%; 3) a prominent tuberculum sella protruding above a line connecting the optic nerves as they entered the optic canals in 44%; and 4) carotid arteries approaching within 4 mm of midline within or above the sella turcica in 12%.

Neurovascular relationships of the sphenoid sinus

1979 ◽  
Vol 50 (1) ◽  
pp. 31-39 ◽  
Author(s):  
Kiyotaka Fujii ◽  
Steven M. Chambers ◽  
Albert L. Rhoton
Keyword(s):  
Sphenoid Sinus ◽  
Carotid Arteries ◽  
Lateral Wall ◽  
Bone Thickness ◽  
Optic Nerves ◽  
Content Type ◽  
Vascular Structures ◽  
Trigeminal Nerves ◽  
Sinus Mucosa ◽  
Fine Print

✓ The increasing use of the transsphenoidal approach to sellar tumors has created a need for more detailed information about the neurovascular relationships of the sphenoid sinus. To better define this anatomy, 25 sphenoid sinuses were examined in cadavers, with attention to the neural and vascular structures in the lateral wall of the sinus. Three structures produced prominent bulges into the lateral wall of the sinus; they were 1) the optic nerves, 2) the carotid arteries, and 3) the maxillary branches of the trigeminal nerve. Over half of these structures had a bone thickness of less than 0.5 mm separating them from the sphenoid sinus, and in a few cases, they were separated by only sinus mucosa and dura. 1) The optic canals protruded into the superolateral part of the sphenoid sinus in all except one side of one specimen. In 4% of the optic nerves, only the optic sheath and sinus mucosa separated the nerves from the sinus, and in 78%, less than a 0.5-mm thickness of bone separated them. 2) The carotid arteries produced a prominent bulge into the sphenoid sinus in all but one side of one specimen. In 8% of the carotid arteries there were areas where no bone separated the artery and the sinus. 3) The maxillary branches of trigeminal nerves bulged into the inferolateral part of the sphenoid sinus in all except one side of two specimens. One side of one specimen had no bone, and 70% had less than a 0.5-mm thickness of bone separating the nerve from the sinus. The importance of these findings in transsphenoidal surgery is reviewed.

Thickening of sphenoid sinus mucosa during the acute stage of pituitary apoplexy

2001 ◽  
Vol 95 (5) ◽  
pp. 897-901 ◽  
Author(s):  
Kazunori Arita ◽  
Kaoru Kurisu ◽  
Atushi Tominaga ◽  
Kazuhiko Sugiyama ◽  
Fusao Ikawa ◽  
...  
Keyword(s):  
Transsphenoidal Surgery ◽  
Sphenoid Sinus ◽  
Pituitary Apoplexy ◽  
Sella Turcica ◽  
Acute Stage ◽  
Mr Images ◽  
Content Type ◽  
Subepithelial Layer ◽  
Sinus Mucosa ◽  
Fine Print

✓ The authors treated two patients with pituitary apoplexy in whom magnetic resonance (MR) images were obtained before and after the episode. Two days after the apoplectic episodes, MR imaging demonstrated marked thickening of the mucosa of the sphenoid sinus that was absent in the previous studies. The relevance of this change in the sphenoid sinus was investigated. Retrospective evaluations were performed using MR images obtained in 14 consecutive patients with classic pituitary apoplexy characterized by acute onset of severe headache. The mucosa of the sphenoid sinus had thickened predominantly in the compartment just beneath the sella turcica, in nine of 11 patients, as ascertained on MR images obtained within 7 days after the onset of apoplectic symptoms. This condition improved spontaneously in all four patients who did not undergo transsphenoidal surgery. The sphenoid sinus mucosa appeared to be normal on MR images obtained from three patients at the chronic stage (> 3 months after onset). The incidence of sphenoid sinus mucosal thickening during the acute stage was significantly higher in the patients with apoplexy than that in the 100 patients without apoplexy. A histological study conducted in four patients who underwent transsphenoidal surgery during the early stage showed that the subepithelial layer of the sphenoid sinus mucous membrane was obviously swollen. The sphenoid sinus mucosa thickens during the acute stage of pituitary apoplexy. This thickening neither indicates infectious sinusitis nor rules out the choice of the transsphenoidal route for surgery.

Bitemporal hemianopsia associated with sclerosis of the intracranial internal carotid arteries

1980 ◽  
Vol 53 (4) ◽  
pp. 566-569 ◽  
Author(s):  
Koichi Matsuo ◽  
Shigeaki Kobayashi ◽  
Kenichiro Sugita
Keyword(s):  
Carotid Arteries ◽  
Internal Carotid ◽  
Visual Fields ◽  
Optic Nerves ◽  
Content Type ◽  
Surgical Exploration ◽  
Microsurgical Decompression ◽  
Internal Carotid Arteries ◽  
Fine Print

✓ A case of bitemporal hemianopsia in a 68-year-old woman is reported. Surgical exploration revealed bilateral compression of the optic nerves by the arteriosclerotic internal carotid arteries. Microsurgical decompression with unroofing of the optic canals resulted in prompt recovery of the visual fields.

Microsurgical anatomy of the great cerebral vein of Galen and its tributaries

2003 ◽  
Vol 99 (6) ◽  
pp. 1028-1038 ◽  
Author(s):  
Patrick Chaynes
Keyword(s):  
Venous Drainage ◽  
Pineal Region ◽  
Surgical Approaches ◽  
Cerebral Vein ◽  
Cerebral Veins ◽  
Microsurgical Anatomy ◽  
Vein Of Galen ◽  
Content Type ◽  
Deep Cerebral Veins ◽  
Fine Print

Object. The deep cerebral veins may pose a major obstacle in operative approaches to deep-seated lesions, especially in the pineal region where multiple veins converge on the great cerebral vein of Galen. Because undesirable sequelae may occur from such surgery, the number of veins and branches to be sacrificed during these approaches should kept to a minimum. The purpose of this study was to examine venous drainage into the vein of Galen with a view to surgical approaches. If a vein hampering surgical access must be sacrificed, it can therefore be selected according to the smallest draining territory. Methods. The deep cerebral veins and their surrounding neural structures were examined in 50 cerebral hemispheres from 25 adult cadavers in which the arteries and veins had been perfused with red and blue silicone, respectively. Special consideration was given to the size and location of drainage of the vein of Galen and its tributaries. Conclusions. When a surgeon approaches the pineal region, several veins may hamper the access route. From posterior to anterior, these include the following: the superior vermian and the precentral or superior cerebellar veins, which drain into the posteroinferior aspect of the vein of Galen; and the tectal and pineal veins, which drain into its anterosuperior aspect. The internal occipital vein is the main vessel draining into the lateral aspect of the vein of Galen. It may be joined by the posterior pericallosal vein, and in that case has an extensive territory. To avoid intraoperative venous infarction, it is important to use angiography to determine the venous organization before surgery and to estimate the permeability and size of the branches of the deep venous system.

Stereotaxic thrombosis of inaccessible intracranial aneurysms

1977 ◽  
Vol 47 (6) ◽  
pp. 833-839 ◽  
Author(s):  
Randall W. Smith ◽  
John F. Alksne
Keyword(s):  
Brain Stem ◽  
Cavernous Sinus ◽  
Intracranial Aneurysms ◽  
Sphenoid Sinus ◽  
Ophthalmic Artery ◽  
Sella Turcica ◽  
Content Type ◽  
The Brain ◽  
Stereotaxic Technique ◽  
Fine Print

✓ Some intracranial aneurysms that might be considered inoperable by open craniotomy are readily treatable by stereotaxic thrombosis. This is possible because the stereotaxic technique requires only that some point on the fundus of the aneurysm can be punctured with a needle. Illustrative cases are given describing the successful treatment of aneurysms arising at the origin of the ophthalmic artery, within the cavernous sinus, within the sella turcica, and from the vertebrobasilar and the posterior inferior cerebellar arteries ventral to the brain stem. The aneurysms within the sella or cavernous sinus can be approached through the sphenoid sinus, and the aneurysms ventral to the brain stem can be approached through the clivus without opening the dura.

Surgical strategy for distal anterior cerebral artery aneurysms: microsurgical anatomy

2003 ◽  
Vol 99 (3) ◽  
pp. 517-525 ◽  
Author(s):  
Masatou Kawashima ◽  
Toshio Matsushima ◽  
Tomio Sasaki
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Parallel Line ◽  
Lower Half ◽  
Surgical Strategy ◽  
Surgical Approaches ◽  
Microsurgical Anatomy ◽  
Content Type ◽  
Distal Anterior Cerebral Artery ◽  
Fine Print

Object. Most distal anterior cerebral artery (ACA) aneurysms arise at the pericallosal—callosomarginal artery (PerA—CMA) junction, which is usually located in the A3 segment of the ACA around the genu of the corpus callosum. Aneurysms in the PerA—CMA junction are divided into two types according to their location: supracallosal and infracallosal. Infracallosal distal ACA aneurysms are defined as those located in the lower half of the A3 segment, which makes it more difficult to gain proximal control. In this study, the authors examined the microsurgical anatomy of the distal ACA region, focusing especially on the relationship between the PerA and CMA located in the lower half of the A3 (infracallosal) segment, and present a surgical strategy for dealing with distal ACA aneurysms. Methods. The microsurgical anatomy of the distal ACA region was examined in 22 adult cadaveric cerebral hemispheres after perfusion of the arteries and veins with colored silicone. The relationships of the infracallosal segment of the PerA to the CMA and the A2 segment of the PerA to the frontopolar artery were examined. The distance between the nasion and the site at which a parallel line directed along the long axis of the infracallosal PerA just proximal to the origin of the CMA artery crosses the forehead (which we have named the PC point) was also measured. Surgical approaches to distal ACA aneurysms were examined in stepwise dissections. Conclusions. The PerA—CMA junctions were located in the supracallosal and infracallosal segments of A3 in 36 and 55% of cases, respectively. In the infracallosal region, it was difficult to identify the proximal PerA and to establish proximal control of the vessel. The infracallosal part of the proximal PerA coursed almost parallel to the frontal cranial base, and the PC point was 42.2 ± 15.9 mm (mean ± standard deviation) from the nasion. These findings indicate that there is only a limited space in which to access an infracallosal distal ACA aneurysm below the PC point and establish proximal control by the anterior interhemispheric approach. When the approach is made above the PC point, an anterior callosotomy may be necessary to establish proximal control before final aneurysm dissection and clip placement are completed. The PC point is an important surgical landmark in planning the surgical strategy for infracallosal distal ACA aneurysms.

Suture knot on the repair splint: a simple method to facilitate reconstruction of the sella turcica during endonasal endoscopic transsphenoidal surgery

2005 ◽  
Vol 102 (5) ◽  
pp. 938-939 ◽  
Author(s):  
Shigeki Kubo ◽  
Hiroshi Hasegawa ◽  
Toshihiko Inui ◽  
Shinsuke Tominaga ◽  
Toshiki Yoshimine
Keyword(s):  
Transsphenoidal Surgery ◽  
Sella Turcica ◽  
Endoscopic Approach ◽  
Tumor Removal ◽  
Endoscopic Transsphenoidal Surgery ◽  
Simple Method ◽  
Content Type ◽  
Narrow Space ◽  
Sellar Floor ◽  
Fine Print

✓ Reconstruction of the sellar floor after pituitary tumor removal is sometimes difficult because the repair graft is difficult to handle in the narrow space. This is especially problematic if the endonasal endoscopic approach is used. The authors devised a technique to facilitate this procedure by placing a suture knot on the repair splint. This allows the material to be grasped securely with forceps and improves manipulation even within the narrow nasal cavity. This technique has proved useful when performing the endonasal endoscopic approach, and it is also expected to be useful when conducting the conventional sublabial transsphenoidal approach.

Harvey Cushing and Oskar Hirsch: early forefathers of modern transsphenoidal surgery

2005 ◽  
Vol 103 (6) ◽  
pp. 1096-1104 ◽  
Author(s):  
James K. LIU ◽  
Aaron A. Cohen-Gadol ◽  
Edward R. Laws ◽  
Chad D. Cole ◽  
Peter Kan ◽  
...  
Keyword(s):  
Transsphenoidal Surgery ◽  
Sphenoid Sinus ◽  
Sella Turcica ◽  
Future Generations ◽  
Content Type ◽  
Harvey Cushing ◽  
Transnasal Surgery ◽  
Sublabial Approach ◽  
First Time ◽  
Fine Print

✓ The transnasal transsphenoidal approach is the preferred route for removal of most lesions of the sella turcica. The concept of transnasal surgery traversing the sphenoid sinus to reach the sella has existed for nearly a century. A comprehensive historical overview of the evolution of transsphenoidal surgery has been reported previously. In the present vignette, the authors focus on transsphenoidal surgery in the early 1900s, particularly on the methods advocated by Harvey Cushing and Oskar Hirsch, two prominent pituitary surgeons who pioneered the transsphenoidal technique. Cushing championed the sublabial approach, whereas Hirsch was the master of the endonasal route. Coincidentally, both surgeons independently performed the submucous septal resection for the first time on June 4, 1910. Although Cushing's and Hirsch's approaches were predicated on the work of their predecessors, their transsphenoidal procedures became the two most popular techniques and, for future generations of pituitary surgeons, laid the foundation for modern transsphenoidal surgery. In this comparative analysis, the authors compare the operative nuances of the approaches of Cushing and Hirsch and describe the contributions of these pioneers to modern transsphenoidal surgery.

Carotid-cavernous sinus thrombosis caused by Aspergillus fumigatus

1980 ◽  
Vol 52 (1) ◽  
pp. 120-125 ◽  
Author(s):  
Laligam N. Sekhar ◽  
Manuel Dujovny ◽  
Gutti R. Rao
Keyword(s):  
Aspergillus Fumigatus ◽  
Cavernous Sinus ◽  
Sphenoid Sinus ◽  
Internal Carotid ◽  
Sinus Thrombosis ◽  
Sella Turcica ◽  
Cavernous Sinus Thrombosis ◽  
Content Type ◽  
The Central Nervous System ◽  
Fine Print

✓ A case is presented of Aspergillus fumigatus granuloma involving the sphenoid sinus, sella turcica, cavernous sinus, and the internal carotid artery. The diagnosis was established by a transsphenoidal biopsy. The infection proved difficult to treat and finally remitted after chemotherapy with a combination of amphotericin B, rifampin (rifampicin), and flucytosine (5-fluorocytosine). The spectrum of aspergillosis of the central nervous system is reviewed, and difficulties in treating this infection are considered.

Chiasmapexy for the correction of traction on the optic nerves and chiasm associated with their descent into an empty sella turcica

1971 ◽  
Vol 35 (6) ◽  
pp. 760-764 ◽  
Author(s):  
Keasley Welch ◽  
John C. Stears
Keyword(s):  
Visual Loss ◽  
Sella Turcica ◽  
Empty Sella ◽  
Optic Nerves ◽  
Content Type ◽  
Tumor Bed ◽  
Fine Print

✓ A patient recovered full vision after evacuation of a chromaphobe adenoma and subsequent irradiation, but experienced delayed visual loss in the left eye associated with descent of the diaphragm of the sella and the optic nerves and chiasm into the tumor bed. More normal anatomical relationships were restored by inserting silicone sponge beneath the diaphragm of the sella. Vision improved rapidly thereafter and has been maintained for more than 3½ years.

Sign in / Sign up

Export Citation Format

Share Document