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Das KK, Singh K, Mehrotra A, Jaiswal AK. Contralateral supraorbital eyebrow approach for tuberculum sellae meningioma. Acta Neurochir (Wien) 2023; 165:2925-2929. [PMID: 37452902 DOI: 10.1007/s00701-023-05714-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/02/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The main challenge in tuberculum sellae meningioma (TSM) resection is the safe dissection of the optic nerves, which many a times are compressed and distorted by the tumor. While intuitive, an approach from the side of predominant tumor extension makes tumor dissection from the medial surface of the ipsilateral optic nerve rather blind. We describe here a contralateral supraorbital eyebrow approach (c-SEA) to address this "blind spot." METHOD c-SEA was performed using a 2 × 2 cm craniotomy. The patient improved after surgery and postoperative imaging confirmed the totality of the tumor resection. CONCLUSION c-SEA can be an excellent minimally invasive option for asymmetric TSM.
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Affiliation(s)
- Kuntal Kanti Das
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
| | - Kavindra Singh
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anant Mehrotra
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Awadhesh Kumar Jaiswal
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Agosti E, Saraceno G, Rampinelli V, Raffetti E, Veiceschi P, Buffoli B, Rezzani R, Giorgianni A, Hirtler L, Alexander AY, Deganello A, Piazza C, Nicolai P, Castelnuovo P, Locatelli D, Peris-Celda M, Fontanella MM, Doglietto F. Quantitative Anatomic Comparison of Endoscopic Transnasal and Microsurgical Transcranial Approaches to the Anterior Cranial Fossa. Oper Neurosurg (Hagerstown) 2022; 23:e256-e266. [PMID: 36106936 DOI: 10.1227/ons.0000000000000312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 04/12/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Several microsurgical transcranial approaches (MTAs) and endoscopic transnasal approaches (EEAs) to the anterior cranial fossa (ACF) have been described. OBJECTIVE To provide a preclinical, quantitative, anatomic, comparative analysis of surgical approaches to the ACF. METHODS Five alcohol-fixed specimens underwent high-resolution computed tomography. The following approaches were performed on each specimen: EEAs (transcribriform, transtuberculum, and transplanum), anterior MTAs (transfrontal sinus interhemispheric, frontobasal interhemispheric, and subfrontal with unilateral and bilateral frontal craniotomy), and anterolateral MTAs (supraorbital, minipterional, pterional, and frontotemporal orbitozygomatic approach). An optic neuronavigation system and dedicated software (ApproachViewer, part of GTx-Eyes II-UHN) were used to quantify the working volume of each approach and extrapolate the exposure of different ACF regions. Mixed linear models with random intercepts were used for statistical analyses. RESULTS EEAs offer a large and direct route to the midline region of ACF, whose most anterior structures (ie, crista galli, cribriform plate, and ethmoidal roof) are also well exposed by anterior MTAs, whereas deeper ones (ie, planum sphenoidale and tuberculum sellae) are also well exposed by anterolateral MTAs. The orbital roof region is exposed by both anterolateral and lateral MTAs. The posterolateral region (ie, sphenoid wing and optic canal) is well exposed by anterolateral MTAs. CONCLUSION Anterior and anterolateral MTAs play a pivotal role in the exposure of most anterior and posterolateral ACF regions, respectively, whereas midline regions are well exposed by EEAs. Furthermore, certain anterolateral approaches may be most useful when involvement of the optic canal and nerves involvement are suspected.
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Affiliation(s)
- Edoardo Agosti
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.,Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Giorgio Saraceno
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Elena Raffetti
- Department of Global Public Health Sciences, Karolinska Institute, Stockholm, Sweden.,Center for Natural Hazards and Disaster Science, Uppsala University, Uppsala, Sweden
| | - Pierlorenzo Veiceschi
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Barbara Buffoli
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Rita Rezzani
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Giorgianni
- Department of Neuroradiology, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Lena Hirtler
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | | | - Alberto Deganello
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology-Head and Neck Surgery, University of Padua-Azienda Ospedaliera di Padova, Padua, Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, Ospedale di Circolo, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Davide Locatelli
- Division of Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Maria Peris-Celda
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Marco Maria Fontanella
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Francesco Doglietto
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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Henderson F, Youngerman BE, Niogi SN, Alexander T, Tabaee A, Kacker A, Anand VK, Schwartz TH. Endonasal transsphenoidal surgery for planum sphenoidale versus tuberculum sellae meningiomas. J Neurosurg 2022; 138:1338-1346. [PMID: 36461840 DOI: 10.3171/2022.8.jns22632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/09/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
The aim of this study was to determine if the distinction between planum sphenoidale (PS) and tuberculum sellae (TS) meningiomas is clinically meaningful and impacts the results of the endoscopic endonasal approach (EEA).
METHODS
A consecutive series of patients who were 18 years of age or older and underwent EEA for newly diagnosed grade I PS meningiomas (PSMs) and TS meningiomas (TSMs) between October 2007 and May 2021 were included. The PS and TS were distinguished by drawing a line passing through the center of the TS and perpendicular to the PS on postcontrast T1-weighted MRI. Probabilistic heatmaps were created to display the actual distribution of tumor volumes. Tumor volume, extent of resection (EOR), visual outcome, and complications were assessed.
RESULTS
The 47 tumors were distributed in a smooth continuum. Using an arbitrary definition, 24 (51%) were PSMs and 23 (49%) were TSMs. The mean volume of PSMs was 5.6 cm3 compared with 4.5 cm3 for TSMs. Canal invasion was present in 87.5% of PSMs and 52% of TSMs. GTR was achieved in 38 (84%) of 45 cases in which it was the goal, slightly less frequently for PSMs (78%) compared with TSMs (91%), although the difference was not significant. Th mean EOR was 99% ± 2% for PSMs and 98% ± 11% for TSMs. Neither the suprasellar notch angle nor the percentage of tumor above the PS impacted the rate of GTR. After a median follow-up of 28.5 months (range 0.1–131 months), there were 2 (5%) recurrences after GTR (n = 38) both of which occurred in patients with PSMs. Forty-two (89%) patients presented with preoperative impaired vision. Postoperative vision was stable or improved in 96% of patients with PSMs and 91% of patients with TSMs. CSF leakage occurred in 4 (16.6%) patients with a PSM, which resolved with only lumbar drainage, and in 1 (4.3%) patient with a TSM, which required reoperation.
CONCLUSIONS
PSM and TSMs arise in a smooth distribution, making the distinction arbitrary. Those classified as PSMs were larger and more likely to invade the optic canals. Surgical outcome for both locations was similar, slightly favoring TSMs. The arbitrary distinction between PSMs and TSMs is less useful at predicting outcome than the lateral extent of the tumor, regardless of the site of origin.
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Affiliation(s)
| | - Brett E. Youngerman
- Department of Neurosurgery, Columbia University Medicine, NewYork-Presbyterian Hospital, New York, New York; and
| | | | - Tyler Alexander
- Thomas Jefferson University, School of Medicine, Philadelphia, Pennsylvania
| | - Abtin Tabaee
- Otolaryngology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
| | - Ashutosh Kacker
- Otolaryngology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
| | - Vijay K. Anand
- Otolaryngology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
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Matys T, Scoffings DJ, Massoud TF. Anatomy of the Calvaria and Skull Base. Neuroimaging Clin N Am 2022; 32:447-462. [PMID: 35843655 DOI: 10.1016/j.nic.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
A thorough understanding of the skull anatomy is of key importance to radiologists as well as specialist physicians and surgeons. We describe the anatomy of the neurocranium comprising calvaria (the skull vault) and the skull base and discuss the most common and clinically relevant anatomic variants.
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Affiliation(s)
- Tomasz Matys
- Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, UK; Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, UK.
| | - Daniel J Scoffings
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QQ, UK. https://twitter.com/brainscandan
| | - Tarik F Massoud
- Division of Neuroimaging and Neurointervention, Department of Radiology, Stanford University School of Medicine, Stanford Health Centre, Palo Alto, CA, USA
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Change in the Location of the Optic Strut Relative to the Anterior Clinoid Process Pneumatization. J Craniofac Surg 2022; 33:1924-1928. [PMID: 35905388 DOI: 10.1097/scs.0000000000008707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/14/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This study aimed to peruse the alteration of the position of the optic strut (OS) according to the anterior clinoid process (ACP) pneumatization. METHODS This retrospective study conducted on cone-beam computed tomography images of 400 patients with a mean age of 36.49±15.91 years. RESULTS Anterior clinoid process length, width, and angle were measured as 10.56±2.42 mm, 5.46±1.31 mm, and 42.56±14.68 degrees, respectively. The tip of ACP was measured as 6.60±1.50 mm away from the posterior rim of OS. In the 631 sides (78.87%) did not have ACP pneumatization. In the cases with ACP pneumatization, three different configurations were identified as follows: Type 1 in 71 sides (8.87%), Type 2 in 56 sides (7%), and Type 3 in 42 sides (5.23%). Relative to ACP, the location of OS was determined as follows: Type A in 29 sides (3.64%), Type B in 105 sides (13.12%), Type C in 344 sides (43%), Type D in 289 sides (36.12%), and Type E in 33 sides (4.12%). The spread of data related to the attachment site of OS according to the presence or absence of ACP pneumatization showed that the location of OS was affected by ACP pneumatization (P<0.001). In ACPs with pneumatization, the frequency of OS position relative to ACP was found as follows: Type A in none of sides (0%), Type B in 8 sides (7.6%), Type C in 53 sides (15.4%), Type D in 88 sides (30.4%), and Type E in 20 sides (60.6%). CONCLUSIONS The main finding of this study was that the location of OS relative to ACP was affected by ACP pneumatization. In ACPs with pneumatization, OS was located more posteriorly compared with ACPs without pneumatization.
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Endoscopic endonasal surgical anatomy through the prechiasmatic sulcus: the key window to suprachiasmatic and infrachiasmatic corridors. Acta Neurochir (Wien) 2022; 164:1929-1938. [PMID: 35410400 DOI: 10.1007/s00701-022-05196-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/26/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND Classically, the transtuberculum and transplanum approaches have been utilized to reach the suprachiasmatic and infrachiasmatic corridors. The aim of this study was to provide a better understanding of the key endoscopic endonasal anatomy of the suprachiasmatic and infrachiasmatic corridors provided through selective removal of the prechiasmatic sulcus (SRPS). METHOD A SRPS was performed in 16 sides of 8 alcohol-fixed head specimens. Twenty anatomical measurements were collected on the suprachiasmatic and infrachiasmatic corridors. The transplanum and transtuberculum approaches were also performed. RESULTS In the suprachiasmatic corridor, the SRPS exposed the anterior communicating artery (AComm) and the post-communicating segment of the anterior cerebral arteries in all the cases, while the pre-communicating segment of the anterior cerebral arteries, recurrent arteries of Heubner, and fronto-orbital arteries were visualized in 75% (12/16), 31% (5/16), and 69% (11/16) of cases, respectively. In the infrachiasmatic corridor, the ophthalmic segment of the internal carotid artery and superior hypophyseal arteries were always visible through the SRPS. The mean width and height of the prechiasmatic sulcus were 13.2 mm and 9.6 mm, respectively. The mean distances from the midpoint of the AComm to the anterior margin of the optic chiasm (OCh) was 5.3 mm. The mean width of the infrachiasmatic corridor was 12.3 mm at the level of the proximal margin of the ophthalmic segment of the internal carotid artery. The mean distances from the posterior superior limit of the pituitary stalk to the basilar tip and oculomotor nerve were 9.7 mm and 12.3 mm, respectively. CONCLUSIONS The SRPS provides access to the main neurovascular and cisternal surgical landmarks of the suprachiasmatic and infrachiasmatic corridors. This anatomical area constitutes the key part of the approach to the suprasellar area. To afford adequate surgical maneuverability, the transplanum or transtuberculum approaches are usually a necessary extension.
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Evaluation of the Cranial Aperture of the Optic Canal on Cone-Beam Computed Tomography Images and its Clinical Implications for the Transcranial Approaches. J Craniofac Surg 2022; 33:1909-1913. [PMID: 35175983 DOI: 10.1097/scs.0000000000008577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/29/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This study aimed to investigate morphometric properties of the cranial aperture (CA) of the optic canal. METHODS Cone-beam computed tomography images of 400 individuals (200 males and 200 females) aged 37.32 ± 15.87 years were retrospectively examined to assess the morphometry and morphology of the CA. RESULTS The height and width of CA were found as 4.22 ± 0.74 mm and 7.27 ± 1.15 mm, respectively. The distances between the CA and the midsagittal line, the anterior and lateral boundaries of the anterior skull base were measured as 5.77 ± 1.32 mm, 64.97 ± 6.36 mm, and 41.00 ± 4.05, respectively. The angle of the optic canal in the sagittal plane was measured as 7.57° ± 3.95°, whereas in the horizontal plane as 38.96° ± 4.36°. The aperture shape was defined as the tear-drop (413 foramina, 51.62%), triangular (180 foramina, 22.50%), oval (158 foramina, 19.75%), round (30 foramina, 3.75%), and polygonal (19 foramina, 2.38%). CONCLUSIONS The authors observed that the diameters, and angulations of the CA may change relative to gender and the shape. The anatomic features of CA are important for the positioning of the patient's head, the choice of the appropriate surgical approach or equipment, and the detection of anatomical landmarks during interventions. In this context, our dataset may be beneficial for surgeons helpful as a reference for radiological evaluations.
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Straus D, Eddelman DB, Byrne N, Tchalukov K, Wewel J, Munich SA, Kocak M, Byrne R. Anatomical Predictors of Transcranial Surgical Access to the Suprasellar Space. J Neurol Surg B Skull Base 2021; 82:365-369. [PMID: 34026414 DOI: 10.1055/s-0039-3400298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/06/2019] [Indexed: 10/25/2022] Open
Abstract
Objective The suprasellar space is a common location for intracranial lesions. The position of the optic chiasm (prefixed vs. postfixed) results in variable sizes of operative corridors and is thus important to identify when choosing a surgical approach to this region. In this study, we aim to identify relationships between suprasellar anatomy and external cranial metrics to guide in preoperative planning. Methods T2-weighted magnetic resonance images (MRIs) from 50 patients (25 males and 25 females) were analyzed. Various intracranial and extracranial metrics were measured. Statistical analysis was performed to determine any associations between metrics. Results Interoptic space (IOS) size correlated with interpupillary distance (IPD; a = 7.3, 95% confidence interval [CI] = 4.5-10.0, R 2 = 0.3708, p = 0.0009). IOS size also correlated with fixation of the optic chiasm, for prefixed chiasms ( n = 7), the mean IOS is 205.14 mm 2 , for normal chiasm position ( n = 33) the mean IOS is 216.94 mm 2 and for postfixed chiasms ( n = 10) the mean IOS is 236.20 mm 2 ( p = 0.002). IPD correlates with optic nerve distance (OND; p = 0.1534). Cranial index does not predict OND, IPD, or IOS. Conclusion This study provides insight into relationships between intracranial structures and extracranial metrics. This is the first study to describe a statistically significant correlation between IPD and IOS. Surgical approach can be guided in part by the size of the IOS and its correlates. Particularly small intraoptic space may guide the surgeon away from a subfrontal approach.
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Affiliation(s)
- David Straus
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Daniel B Eddelman
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Nika Byrne
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Konstantin Tchalukov
- Rush Medical College, Rush University Medical Center, Chicago, Illinois, United States
| | - Josh Wewel
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Stephan A Munich
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Mehmet Kocak
- Department of Radiology, Rush University Medical Center, Chicago, Illinois, United States
| | - Richard Byrne
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
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Abstract
OBJECTIVE This study was aimed to obtain data on the dimensions of the optic foramen in human fetuses for early childhood surgeries. METHODS Twenty-five formalin-fixed fetuses (16 boys and 9 girls) with average age 21.68 ± 3.12 gestational weeks (range, 16-28 weeks) in the inventory of Anatomy Department, Faculty of Medicine were included in the study. The surface area, width, and height of the optic foramen were bilaterally measured using a digital image analysis software. RESULTS The forms of the optic foramen were described as oval shaped (72%, 36 foramina) and round shaped (28%, 14 foramina). The surface area, width, and height of the optic foramen were found as 2.40 ± 1.02 mm, 1.83 ± 0.59 mm, and 1.58 ± 0.36 mm, respectively. The measurements of the parameters related to the optic foramen were not statistically different in terms of sides and sexes (P > 0.05). Linear functions for the height, width and surface area of the optic foramen were calculated as: y = 0.711 + 0.040 × weeks, y = -0.019 + 0.086 × weeks, and y = -0.400 + 0.129 × weeks, respectively. CONCLUSION The linear functions in this study can be used to estimate the dimensions of the optic foramen. The calculated regression equations, representing the growth dynamic of the optic foramen showed that the surface area, width, and height were increasing according to gestational ages between 16 and 28 weeks. Microanatomical knowledge related to the optic foramen may be beneficial for surgeons to avoid iatrogenic injury in infants and for anatomists to understand the development of the fetal skull base.
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Abstract
OBJECTIVE The study aimed to identify the chiasmatic ridge (CR) morphology and to discuss its surgical significance. METHODS The suprasellar region of 90 adult dry skulls with unknown ages, sexes, or nationalities was examined to record the shape and incidence of the CR. RESULTS The CR was found in 14 (15.56%) of 90 dry skulls. The ridge was classified into 3 types, taking into account its shape, incidence (presence/absence), and the risk of residual tumor formation. The absence of the CR was named as Type 1 (76 cases, 84.44%). The bony extension without a hidden area was identified as Type 2 (8 cases, 8.89%), while the bony extension with a hidden area as Type 3 (6 cases, 6.67%). CONCLUSION Type 3 CR (which has an evident hidden area beneath the ridge) should be taken into account by neurosurgeons to eliminate possible residual tumor risk during removal of tumors (eg, meningioma) with subfrontal or supraorbital approaches.
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Lockwood J, Mathkour M, Nerva JD, Iwanaga J, Bui CJ, Vale FL, Dumont AS, Tubbs RS. Anatomic Study Quantifying the Relationship Between the Arcuate Eminence and the Root of the Zygoma: Application to Skull Base Surgery. World Neurosurg 2020; 146:e773-e778. [PMID: 33181377 DOI: 10.1016/j.wneu.2020.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/03/2020] [Accepted: 11/03/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to define the structural relationship between the arcuate eminence (AE) and a known fixed external bony landmark, the root of the zygoma (ZR), and to determine its reliability as a consistent guide for guiding surgical approaches. To our knowledge, this is the only anatomic study to quantify the relationship between the AE and ZR. METHODS Twenty-one dry temporal bones were measured using digital calipers. The distance from the posterior aspect of the ZR to the midpoint of the AE was measured. Additionally, the anteroposterior distance between the ZR and AE and vertical distance between the 2 structures were measured. Student's t-test was used to compare the left and right sides. RESULTS An AE was found in every specimen. The mean ZR to AE distance was 30.9 mm. On most sides (91%), the ZR was located more inferiorly than the AE with a mean distance of 3 mm between the 2 structures. The mean distance between the AE and ZR was 17 mm. On all sides, the AE was located posterior to the ZR. No significant differences were found between sides. No anatomic variations or pathologic conditions were noted in any of the specimens. CONCLUSIONS The ZR is an easily identifiable and consistent bony landmark often used by skull base surgeons. In this investigation, we measured the anatomic relationships between the ZR and AE. Such data might assist in planning surgical trajectories and minimizing complications when skull base pathologies are approached.
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Affiliation(s)
- Joseph Lockwood
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
| | - Mansour Mathkour
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA; Neurosurgery Division, Surgery Department, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - John D Nerva
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan; Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA.
| | - C J Bui
- Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
| | - Fernando L Vale
- Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA; Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Anatomical Sciences, St. George's University School of Medicine, St. George's, Grenada
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Anatomic features of the cranial aperture of the optic canal in children: a radiologic study. Surg Radiol Anat 2020; 43:187-199. [PMID: 33130955 DOI: 10.1007/s00276-020-02604-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aimed to peruse anatomic features of the cranial aperture of the optic canal (CAOC) for obtaining an extended morphometric dataset in children. METHODS Computed tomography images of 200 children were included in this retrospective work to analyze the shape, location and diameters of the CAOC. RESULTS The CAOC area, width and height were observed as 17.53 ± 2.80 mm2, 6.12 ± 0.84 mm, and 4.35 ± 0.64 mm, respectively. The angle of the optic canal in axial plane was found as 39.28 ± 5.13°, while in sagittal plane as 16.01 ± 6.76°. The distance between the CAOC and the midsagittal line was 7.17 ± 1.48 mm. The CAOC was measured as 54.04 ± 5.23 mm and 42.55 ± 3.28 mm away from the anterior and lateral boundary of the anterior skull base, respectively. The CAOC shape was described as the tear-drop (186 foramina, 46.5%), triangular (156 foramina, 39%), oval (47 foramina, 11.8%), and round (11 foramina, 2.8%). CONCLUSION The depth, angle and diameter measurements belonging to the CAOC were changing according to its shape or demographic data (e.g., sex and age). Therefore, preoperative radiologic evaluation containing the shape, location and size of the CAOC should be considered by multidisciplinary operating teams in terms of surgical interventions such as implant positioning.
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Beger O, Ten B, Balcı Y, Çakır S, Özalp H, Hamzaoğlu V, Vayisoğlu Y, Dağtekin A, Bağdatoğlu C, Talas DÜ. A Computed Tomography Study of the Prechiasmatic Sulcus Anatomy in Children. World Neurosurg 2020; 141:e118-e132. [PMID: 32413566 DOI: 10.1016/j.wneu.2020.05.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 04/30/2020] [Accepted: 05/02/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate the characteristics of the prechiasmatic sulcus in children aged between 1-20 years. METHODS Patient files of 200 children admitted to the university hospital on 2019 were analyzed, retrospectively. The computed tomography images of patients were used to obtain anatomical knowledge containing prechiasmatic sulcus types and dimensions. RESULTS The measurements related to the sulcal length (6.94 ± 1.25 mm) and sulcal angle (31.01 ± 18.13°) showed that the sulcal length did not alter in children between 1 and 20 years, whereas the sulcal angle did not vary from infancy to prepubescent period, but it was decreasing in postpubescent period. In 29 patients, the sulcal length was observed to divide into 2 parts with an evident angle. The interoptic distance and planum length were found as follows: 14.70 ± 2.85 mm and 14.84 ± 4.12 mm, respectively. The order of PS types was observed as type 4 (26.5%, 53 cases) > type 2 (26%, 52 cases) > type 1 (24%, 48 cases) > type 3 (23.5%, 47 cases). CONCLUSIONS The sulcal length did not vary in children, whereas the sulcal angle decreased with an irregular pattern. The sulcal angle decreased after prepubescent period, possibly due to the sphenoid sinus pneumatization and spheno-occipital synchondrosis. The sulcal length angle mostly in infants and young children may cause surgical orientation difficult during the resection of tumors using transcranial approaches.
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Affiliation(s)
- Orhan Beger
- Department of Anatomy, Mersin University Faculty of Medicine, Mersin, Turkey; Mersin University Faculty of Medicine, Mersin, Turkey.
| | - Barış Ten
- Department of Radiology Mersin University Faculty of Medicine, Mersin, Turkey; Mersin University Faculty of Medicine, Mersin, Turkey
| | - Yüksel Balcı
- Department of Radiology Mersin University Faculty of Medicine, Mersin, Turkey; Mersin University Faculty of Medicine, Mersin, Turkey
| | - Salim Çakır
- Mersin University Faculty of Medicine, Mersin, Turkey
| | - Hakan Özalp
- Department of Neurosurgery, Mersin University Faculty of Medicine Mersin, Turkey; Mersin University Faculty of Medicine, Mersin, Turkey
| | - Vural Hamzaoğlu
- Department of Neurosurgery, Mersin University Faculty of Medicine Mersin, Turkey; Mersin University Faculty of Medicine, Mersin, Turkey
| | - Yusuf Vayisoğlu
- Department of Otorhinolaryngology, Mersin University Faculty of Medicine, Mersin, Turkey; Mersin University Faculty of Medicine, Mersin, Turkey
| | - Ahmet Dağtekin
- Department of Neurosurgery, Mersin University Faculty of Medicine Mersin, Turkey; Mersin University Faculty of Medicine, Mersin, Turkey
| | - Celal Bağdatoğlu
- Department of Neurosurgery, Mersin University Faculty of Medicine Mersin, Turkey; Mersin University Faculty of Medicine, Mersin, Turkey
| | - Derya Ümit Talas
- Department of Otorhinolaryngology, Mersin University Faculty of Medicine, Mersin, Turkey; Mersin University Faculty of Medicine, Mersin, Turkey
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Peto I, White TG, Dehdashti AR. How I do it: contralateral supraorbital approach for tuberculum sellae meningioma. Acta Neurochir (Wien) 2020; 162:613-616. [PMID: 31900657 DOI: 10.1007/s00701-019-04205-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 12/27/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND The resection of tuberculum sellae meningiomas poses a challenge particularly when dealing with the medial aspect of the optic nerve. Dissection of the tumor off the optic nerve is usually carried out in the blind spot "behind" the optic nerve. We describe a contralateral approach for asymmetric tuberculum sellae meningiomas, allowing direct visualization of the medial optic nerve. METHOD Contralateral lateral supraorbital approach was performed, and complete tumor resection was achieved without any injury to the optic nerve. CONCLUSION The contralateral approach for asymmetric tuberculum sellae meningioma is an efficient technique allowing improved visualization of the medial optic nerve.
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Affiliation(s)
- Ivo Peto
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, 33606, USA.
| | - Timothy G White
- Department of Neurosurgery, Hofstra Northwell School of Medicine, Manhasset, NY, 11030, USA
| | - Amir R Dehdashti
- Department of Neurosurgery, Hofstra Northwell School of Medicine, Manhasset, NY, 11030, USA
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Beger O, Taghipour P, Çakır S, Hamzaoğlu V, Özalp H, Kara E, Vayisoğlu Y, Dağtekin O, Dağtekin A, Bağdatoğlu C, Öztürk AH, Talas DÜ. Fetal Anatomy of the Optic Strut and Prechiasmatic Sulcus with a Clinical Perspective. World Neurosurg 2020; 136:e625-e634. [PMID: 32001393 DOI: 10.1016/j.wneu.2020.01.125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 01/13/2020] [Accepted: 01/16/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The main objective of the study was to show the morphologic features of optic strut (OS) and prechiasmatic sulcus (PS) in the fetal skull base with a surgical anatomical perspective. METHODS Twenty-three fetal cadavers (9 female, 14 male) with an average age of 21.70 ± 3.12 (range: 16-28) weeks of gestation in the inventory of the Anatomy Department were included in the study. Measurements were made with a digital image analysis software and goniometer. RESULTS The sulcal length, interoptic distance, planum length, and sulcal angle were detected as follows: 3.91 ± 0.74 mm, 6.88 ± 1.04 mm, 6.55 ± 1.51 mm, and 24.52 ± 9.51°, respectively. Considering the location of the posteromedial margin of OS according to PS, OS was identified as the sulcal in 56.5% (13 cases), postsulcal in 30.4% (7 cases), and asymmetric in 13% (3 cases). According to the sulcal length and angle, PS was identified as type 1 in 26.1% (6 cases), type 2 in 21.7% (5 cases), type 3 in 30.4% (7 cases), and type 4 in 21.7% (5 cases). CONCLUSIONS Our findings suggest that the sulcal length and angle reach adult size in utero. Taking into account the fetal and the gathered adult measurements, the high percentage of steep angle compared to flat angle show that after birth, PS become more flat, probably depending on the variations of the sphenoid sinus pneumatization. Thus, more studies conducted on the alterations in PS and OS types relative to the pneumatization are needed in terms of patient positioning, selection of appropriate surgical approach, and intraoperative decision-making.
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Affiliation(s)
- Orhan Beger
- Department of Anatomy, Mersin University Faculty of Medicine, Mersin, Turkey.
| | | | - Salim Çakır
- Mersin University Medical School, Mersin, Turkey
| | - Vural Hamzaoğlu
- Department of Neurosurgery, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Hakan Özalp
- Department of Neurosurgery, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Engin Kara
- Department of Radiology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Yusuf Vayisoğlu
- Department of Otorhinolaryngology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Oykut Dağtekin
- Department of Histology and Embryology, Mersin City Hospital, Mersin, Turkey
| | - Ahmet Dağtekin
- Department of Neurosurgery, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Celal Bağdatoğlu
- Department of Neurosurgery, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Ahmet Hakan Öztürk
- Department of Anatomy, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Derya Ümit Talas
- Department of Otorhinolaryngology, Mersin University Faculty of Medicine, Mersin, Turkey
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Almeida JP, Gentili F. Letter to the Editor. Grading scale for tuberculum sellae meningiomas. Neurosurg Focus 2018; 45:E13. [DOI: 10.3171/2018.5.focus18184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Magill ST, Morshed RA, Lucas CHG, Aghi MK, Theodosopoulos PV, Berger MS, de Divitiis O, Solari D, Cappabianca P, Cavallo LM, McDermott MW. Tuberculum sellae meningiomas: grading scale to assess surgical outcomes using the transcranial versus transsphenoidal approach. Neurosurg Focus 2018; 44:E9. [DOI: 10.3171/2018.1.focus17753] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVETuberculum sellae meningiomas (TSMs) are surgically challenging tumors that can severely impair vision. Debate exists regarding whether the transcranial (TC) or endoscopic transsphenoidal (TS) approach is best for resecting these tumors, and there are few large series comparing these approaches.METHODSA retrospective chart review was performed at 2 academic centers comparing TC and TS approaches with respect to vision, extent of resection, recurrence, and complications. The authors report surgical outcomes and propose a simple preoperative tumor grading scale that scores tumor size (1–2), optic canal invasion (0–2), and arterial encasement (0–2). The authors performed univariate, multivariate, and recursive partitioning analysis (RPA) to evaluate outcomes.RESULTSThe TSMs were resected in 139 patients. The median follow-up was 29 months. Ninety-five (68%) cases were resected via a TC and 44 (32%) via a TS approach. Tumors treated via a TC approach had a higher tumor (p = 0.0007), artery (p < 0.0001), and total score (p = 0.0012) on the grading scale. Preoperative visual deficits were present in 87% of patients. Vision improved in 47%, stayed the same in 35%, declined in 10%, and was not recorded in 8%. The extent of resection was 65% gross-total resection, 23% near-total resection (95%–99% resection), and 12% subtotal resection (< 95%). A lower tumor score was significantly associated with better or stable vision postoperatively (p = 0.0052). The RPA confirmed low tumor score as the key predictor of postoperative visual improvement or stability. Multivariate analysis and RPA demonstrate that lower canal score (p < 0.0001) and TC approach (p = 0.0019) are associated with gross-total resection. Complications occurred in 20 (14%) patients, including CSF leak (5%) and infection (4%). There was no difference in overall complication rates between TC and TS approaches; however, the TS approach had more CSF leaks (OR 5.96, 95% CI 1.10–32.04). The observed recurrence rate was 10%, and there was no difference between the TC and TS approaches.CONCLUSIONSTuberculum sellae meningiomas can be resected using either a TC or TS approach, with low morbidity and good visual outcomes in appropriately selected patients. The simple proposed grading scale provides a standard preoperative method to evaluate TSMs and can serve as a starting point for selection of the surgical approach. Higher scores were associated with worsened visual outcomes and subtotal resection, regardless of approach. The authors plan a multicenter review of this grading scale to further evaluate its utility.
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Affiliation(s)
- Stephen T. Magill
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Ramin A. Morshed
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Calixto-Hope G. Lucas
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Manish K. Aghi
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | | | - Mitchel S. Berger
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Oreste de Divitiis
- 2Divsion of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Domenico Solari
- 2Divsion of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Paolo Cappabianca
- 2Divsion of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Luigi M. Cavallo
- 2Divsion of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Michael W. McDermott
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
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Gol'bin DA, Cherekaev VA. [Variability and age-related features of the anatomy of the midline structures of the anterior skull base]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2018. [PMID: 29543222 DOI: 10.17116/neiro2018821102-110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The article presents the literature data on the structural variability and age-related features of the midline anatomical structures of the anterior skull base (frontal sinus, ethmoid bone, anterior parasellar region, and medial orbital wall). This is the area of surgical interests of neurosurgeons and rhinosurgeons. The study objective is to analyze the literature data on the individual variability and age-related anatomy of these structures. The work is illustrated with original images from the authors' personal archive. The individual anatomical features of eloquent structures in the surgical area (structures within the surgical corridor, key anatomical landmarks, optic tract, internal carotid and ethmoidal arteries, etc.) should be considered in planning surgery in patients of all age groups because they can limit the view and the amount of safe manipulations or increase the risk of complications. The presented data may be useful for neurosurgeons and otolaryngologists whose surgical interests are focused on the midline structures of the anterior skull base.
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Affiliation(s)
- D A Gol'bin
- Burdenko Neurosurgery Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - V A Cherekaev
- Burdenko Neurosurgery Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
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Prechiasmatic sulcus and optic strut: an anatomic study in dry skulls. Acta Neurochir (Wien) 2017; 159:665-676. [PMID: 28213639 DOI: 10.1007/s00701-017-3106-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 01/26/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Although safe surgical access to the cavernous sinus is related to understanding the anatomical and ethnic variants of the prechiasmatic sulcus and the optic strut, there remains a paucity of studies of the morphology and the bony relationships in the region. The present study provides a systematic morphological and morphometric analysis of the sulcal region and the optic strut anatomy and their relations in a Greek population. METHODS The interoptic distance, length of planum sphenoidale, sulcal length and sulcal angle was determined in 96 Greek adult dry skulls. The prechiasmatic sulci and optic struts were morphologically classified and association of sulcal region measures according to type of prechiasmatic sulcus and optic strut were examined. RESULTS Mean interoptic distance was 1.69 ± 0.25 cm; sulcal length, 0.72 ± 0.18 cm; length of planum sphenoidale, 1.86 ± 0.32 cm; sulcal angle, 24.05 ± 17.17°. The sulcal angle was significantly smaller in female skulls compared to males (14.82 ± 12.43 vs 28.29 ± 15.24; p < 0.05). Type I (narrow, steep) prechiasmatic sulci were the most commonly observed (35.8%), followed by Type IV (wide, flat) (32.1%), Type II (narrow, flat) (18.5%) and, finally, Type III (wide, steep) sulci (13.6%). The optic strut was presulcal in 8.3% of specimens, sulcal in 31%, postsulcal in 41.7% and asymmetric in 19%. CONCLUSIONS The present study augments the current knowledge of the morphology of key anatomical landmarks, prechiasmatic sulcus and the optic strut, for cavernous sinus surgery and indicates population and gender differences. We report significant anatomical variations in the prechiasmatic sulcus, optic strut and surrounding structures. In addition to providing a better understanding of the anatomical landmarks, necessary for the safe navigation in transcranial and endoscopic procedures, the present results also suggest that surgeons must consider population differences in determining the anatomical landmarks and navigation points in the sellar region.
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Abstract
The sellar region is a tiny anatomic compartment in which many lesions and developmental diseases can be found. If pituitary adenomas represent most of the sellar mass, it is important to recognize other pathologic conditions before any surgical procedure, because the optimal treatment may differ considerably from one lesion to another. A careful clinical evaluation followed by neuroimaging studies and an endocrinologic and ophtalmologic workup will lead, in most cases, to a diagnosis with near certainty. This article provides an overview of sellar diseases with emphasis on their most useful characteristics for clinical practice.
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Affiliation(s)
- Damien Bresson
- Neurosurgery Department, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, Paris 75010, France
| | - Philippe Herman
- ENT Department, Lariboisière Hospital, Université Paris VII - Diderot, 2 rue Ambroise Paré, Paris 75010, France
| | - Marc Polivka
- Department of Pathology, Lariboisiere Hospital, 2 rue Ambroise Paré, Paris 75010, France
| | - Sébastien Froelich
- Neurosurgery Department, Assistance Publique-Hôpitaux de Paris, Université Paris VII - Diderot, 2 rue Ambroise Paré, Paris 75010, France.
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Endoscopic surgery for tuberculum sellae meningiomas: a systematic review and meta-analysis. Neurosurg Rev 2013; 36:349-59. [PMID: 23568697 DOI: 10.1007/s10143-013-0458-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 01/14/2013] [Accepted: 01/15/2013] [Indexed: 01/28/2023]
Abstract
Recent reports of surgical resection of tuberculum sellae meningiomas through an endoscopic endonasal approach (EEA) have provided an alternative to transcranial approaches in selected cases. However, these published reports have been limited by small sample size from single institutions. We performed a systematic review and meta-analysis to gain insight into potential limitations and benefits of EEA for tuberculum sellae meningiomas. We performed a systematic review of the literature and analyzed pooled data for descriptive statistics on short-term morbidity and outcomes. We compared EEA to transcranial approaches reported during the same time-frame. Six studies (49 patients) met inclusion criteria for EEA. A pooled analysis of transcranial results reported during a similar time period yielded 11 studies (412 patients). There were no differences in rate of gross total resection or peri-operative complications between the two groups. Although the EEA group was associated with higher rates of CSF leak (p < 0.05; OR 3.9; 95 % CI 1.15, 15.75), EEA were also associated with significantly higher rates of post-operative visual improvement compared to transcranial approaches (p < 0.05; OR 1.5; 95 % CI 1.18, 1.82). A systematic review of the small series of EEA for tuberculum sellae meningiomas published to date revealed similar extent of resection and morbidity, but increased post-operative visual improvement compared to transcranial approaches during a similar time period. Long-term follow-up will be needed to define recurrence rates of EEA as compared to transcranial approaches. Cautious use of EEA for the removal of smaller tuberculum sellae meningiomas after formal endoscopic training may be warranted.
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Kunicki J. Tuberculum sellae. J Neurosurg 2012; 116:1398-9; author reply 1399-402. [PMID: 22503121 DOI: 10.3171/2012.1.jns12155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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de Notaris M, Solari D, Cavallo LM, D'Enza AI, Enseñat J, Berenguer J, Ferrer E, Prats-Galino A, Cappabianca P. The "suprasellar notch," or the tuberculum sellae as seen from below: definition, features, and clinical implications from an endoscopic endonasal perspective. J Neurosurg 2011; 116:622-9. [PMID: 22196097 DOI: 10.3171/2011.11.jns111162] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The tuberculum sellae is a bony elevation ridge that lines up the anterior aspect of the sella, dividing it from the chiasmatic groove. The recent use of the endoscopic endonasal transtuberculum approach has provided surgeons with a method to reach the suprasellar area, offering a new surgical point of view somehow "opposite" of this area. The authors of this study aimed to define the tuberculum sellae as seen from the endoscopic endonasal view while also providing CT-based systematic measurements to objectively detail the anatomical features of such a structure, which was renamed the "suprasellar notch." METHODS The authors analyzed routine skull CT scans from 24 patients with no brain pathology or fractures and measured the interoptic distance at the level of the limbus sphenoidale, the chiasmatic groove sulcal length and width, and the angle of the suprasellar notch. Indeed, the suprasellar notch was defined as the angle between 2 lines, the first passing through the tuberculum sellae midpoint and perpendicular to the cribriform plate, and a second line passing between 2 points, the midpoints of the limbus sphenoidale and the tuberculum sellae. Moreover, the authors performed on 15 cadaveric heads an endoscopic endonasal transplanum transtuberculum approach with the aid of a neuronavigator to achieve a step-by-step comparison with the radiological data. The whole CT scanning set was statistically analyzed to determine the statistical interdependency of the suprasellar notch angle with the other 3 measurements, that is, the sulcal length at the midline, the interoptic distance at the optic canal entrance, and the interoptic distance at the limbus. RESULTS Based on the endoscopic endonasal view and CT imaging analysis, the authors identified a certain anatomical variability and thus introduced a new classification of the suprasellar notch: Type I, angle < 118°; Type II, angle of 118°-138°; and Type III, angle > 138°. They then analyzed the surgical implications of the endoscopic endonasal approach to the suprasellar area, which could be affected by each of these structural types. CONCLUSIONS The new classification identifies 3 different types of suprasellar notch and, accordingly, their surgical relevance. Above all, the authors found that the different types of suprasellar notch can affect the osteodural defect reconstruction technique, namely the positioning/wedging of the buttress in the extradural space. A precise endoscopic anatomical knowledge of the neurovascular and bony relationships--especially in cases of a less pneumatized sphenoid sinus--is crucial when approaching the anterior skull base via a transtuberculum transplanum route.
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Affiliation(s)
- Matteo de Notaris
- Department of Radiology, Neuroradiology Division, Faculty of Medicine, Universitat de Barcelona, Spain
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