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Phoominaonin IS, Vargas Rosales AF, Choby GW, Wang EW, Zenonos GA, Snyderman CH, Gardner PA. Carotid Plexus Sympathetic Nerves as a Landmark for the Abducens Nerve Within the Cavernous Sinus During Endoscopic Endonasal Surgery: Cadaveric Anatomic Study and Surgical Consideration. Oper Neurosurg (Hagerstown) 2025; 28:697-704. [PMID: 39185873 DOI: 10.1227/ons.0000000000001334] [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: 05/10/2024] [Accepted: 07/14/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The abducens nerve (CN VI) is vulnerable to injury during endoscopic endonasal transcavernous surgery. In this study, the authors aimed to develop the surgical anatomic landmark and explore the relationship between the sympathetic nerves (SNs) around the internal carotid artery (ICA) and CN VI within the cavernous sinus (CS). METHODS The relationship and patterns between the SNs and CN VI were investigated in 15 cadaveric specimens. The intraoperative examples of anatomic landmark were presented. RESULTS There were SNs around the ICA running into the CN VI, classified into ascending SNs and accessory sympathetic branches. The ascending SNs were divided into 3 types: (1) Type I had a single ascending SN. There were 2 subtypes of Type I (Type IA [17/30, 56.7%] was defined as a single ascending branch that ran into the CN VI, and Type IB [4/30, 13.3%] was defined as a single ascending branch with a terminal bifurcation before merging into the CN VI or lateral CS wall), (2) Type II (7/30, 23.3%) was defined as 2 ascending branches that ran into the CN VI and the lateral CS wall, and (3) Type III (2/30, 6.7%) was defined as 3 ascending branches that ran into the CN VIs and the lateral wall of the CS. The accessory branches of the SNs were defined by sympathetic branches from the posterior genu or horizontal ICA and found in 6/30 sides (20%). CONCLUSION The authors propose a classification of the relationship between paraclival ICA SNs and the CN VI within the CS, as approached during endoscopic endonasal surgery. The consistent relationship of the ascending SN and CN VI within the CS provides a reliable anatomic landmark during the endonasal approach to the CS.
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Affiliation(s)
- I-Sorn Phoominaonin
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh , Pennsylvania , USA
- Department of Health Technology, Navamindradhiraj University, Bangkok , Thailand
| | | | - Garret W Choby
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh , Pennsylvania , USA
| | - Eric W Wang
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh , Pennsylvania , USA
| | - Georgios A Zenonos
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh , Pennsylvania , USA
| | - Carl H Snyderman
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh , Pennsylvania , USA
| | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh , Pennsylvania , USA
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Lefevre E, Dupont S, Liguoro D, Chasseloup F, Kamenicky P, Roblot P. Anatomy of the medial wall of the cavernous sinus: A systematic review of the literature. Clin Anat 2024; 37:910-924. [PMID: 38468565 DOI: 10.1002/ca.24152] [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: 12/13/2023] [Revised: 02/13/2024] [Accepted: 02/22/2024] [Indexed: 03/13/2024]
Abstract
The existence, composition, and continuity of the medial wall of the cavernous sinus (MWCS) have been extensively studied and debated. However, the precise nature of this membrane remains unknown. Understanding the anatomical characteristics of the MWCS is crucial, notably in relation to pituitary adenomas, which often invade the cavernous sinus. Indeed, surgical treatment of those tumors is frequently incomplete because of such invasion. The anatomical and molecular basis of the peculiar and often lateralized tropism of adenomatous cells to the cavernous sinus is not yet understood and it has been suggested repeatedly that the MWCS is physiologically frail. During the past three decades, there have been several conflicting accounts of the existence, composition, and continuity of this medial wall, but methodological differences and varying definitions could have contributed to the current lack of consensus regarding it. The aim of this systematic review was to summarize previously published data concerning the existence, anatomy, composition, and continuity of the MWCS.
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Affiliation(s)
- Etienne Lefevre
- Physiologie et Physiopathologie Endocriniennes, Paris-Saclay University, INSERM U1185, Le Kremlin-Bicêtre, France
- Department of Neurosurgery, APHP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Laboratory of Anatomy, Sorbonne Université, Paris, France
| | - Sophie Dupont
- Laboratory of Anatomy, Sorbonne Université, Paris, France
- Department of Neurology, APHP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Dominique Liguoro
- Neurosurgery Department A, University Hospital of Bordeaux, Bordeaux, France
- Laboratory of Anatomy, Université de Bordeaux, Bordeaux, France
| | - Fanny Chasseloup
- Physiologie et Physiopathologie Endocriniennes, Paris-Saclay University, INSERM U1185, Le Kremlin-Bicêtre, France
- Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des maladies Rares de l'Hypophyse, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Peter Kamenicky
- Physiologie et Physiopathologie Endocriniennes, Paris-Saclay University, INSERM U1185, Le Kremlin-Bicêtre, France
- Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des maladies Rares de l'Hypophyse, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Paul Roblot
- Neurosurgery Department A, University Hospital of Bordeaux, Bordeaux, France
- Laboratory of Anatomy, Université de Bordeaux, Bordeaux, France
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Mosteiro A, Codes M, Tafuto R, Manfrellotti R, Torales J, Enseñat J, Di Somma A, Prats-Galino A. Transorbital approach to the cavernous sinus: an anatomical study of the related cranial nerves. Front Neuroanat 2024; 18:1367533. [PMID: 38693948 PMCID: PMC11061526 DOI: 10.3389/fnana.2024.1367533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/06/2024] [Indexed: 05/03/2024] Open
Abstract
Background The cavernous sinus (CS) is a demanding surgical territory, given its deep location and the involvement of multiple neurovascular structures. Subjected to recurrent discussion on the optimal surgical access, the endoscopic transorbital approach has been recently proposed as a feasible route for selected lesions in the lateral CS. Still, for this technique to safely evolve and consolidate, a comprehensive anatomical description of involved cranial nerves, dural ligaments, and arterial relations is needed. Objective Detailed anatomical description of the CS, the course of III, IV, VI, and V cranial nerves, and C3-C7 segments of the carotid artery, all described from the ventrolateral endoscopic transorbital perspective. Methods Five embalmed human cadaveric heads (10 sides) were dissected. An endoscopic transorbital approach with lateral orbital rim removal, anterior clinoidectomy, and petrosectomy was performed. The course of the upper cranial nerves was followed from their apparent origin in the brainstem, through the middle fossa or cavernous sinus, and up to their entrance to the orbit. Neuronavigation was used to follow the course of the nerves and to measure their length of surgical exposure. Results The transorbital approach allowed us to visualize the lateral wall of the CS, with cranial nerves III, IV, V1-3, and VI. Anterior clinoidectomy and opening of the frontal dura and the oculomotor triangle revealed the complete course of the III nerve, an average of 37 (±2) mm in length. Opening the trigeminal pore and cutting the tentorium permitted to follow the IV nerve from its course around the cerebral peduncle up to the orbit, an average of 54 (±4) mm. Opening the infratrochlear triangle revealed the VI nerve intracavernously and under Gruber's ligament, and the extended petrosectomy allowed us to see its cisternal portion (27 ± 6 mm). The trigeminal root was completely visible and so were its three branches (46 ± 2, 34 ± 3, and 31 ± 1 mm, respectively). Conclusion Comprehensive anatomic knowledge and extensive surgical expertise are required when addressing the CS. The transorbital corridor exposes most of the cisternal and the complete cavernous course of involved cranial nerves. This anatomical article helps understanding relations of neural, vascular, and dural structures involved in the CS approach, essential to culminating the learning process of transorbital surgery.
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Affiliation(s)
- Alejandra Mosteiro
- Laboratory of Surgical Neuroanatomy (LSNA), Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Marta Codes
- Laboratory of Surgical Neuroanatomy (LSNA), Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Roberto Tafuto
- Laboratory of Surgical Neuroanatomy (LSNA), Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università Degli Studi di Napoli “Federico II”, Naples, Italy
| | - Roberto Manfrellotti
- Laboratory of Surgical Neuroanatomy (LSNA), Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
- Division of Neurosurgery, Azienda Socio Sanitaria Territoriale - Monza, Ospedale San Gerardo, Monza, Italy
| | - Jorge Torales
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Joaquim Enseñat
- Laboratory of Surgical Neuroanatomy (LSNA), Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alberto Di Somma
- Laboratory of Surgical Neuroanatomy (LSNA), Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
- Department of Neurological Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alberto Prats-Galino
- Laboratory of Surgical Neuroanatomy (LSNA), Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Agosti E, Alexander AY, Leonel LC, Van Gompel JJ, Link MJ, Pinheiro-Neto CD, Peris-Celda M. Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Endoscopic Endonasal Approach to the Sellar and Parasellar Regions. J Neurol Surg B Skull Base 2023; 84:361-374. [PMID: 37405244 PMCID: PMC10317571 DOI: 10.1055/a-1869-7532] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 06/01/2022] [Indexed: 10/18/2022] Open
Abstract
Introduction Surgery of the sellar and parasellar regions can be challenging due to the complexity of neurovascular relationships. The main goal of this study is to develop an educational resource to help trainees understand the pertinent anatomy and procedural steps of the endoscopic endonasal approaches (EEAs) to the sellar and parasellar regions. Methods Ten formalin-fixed latex-injected specimens were dissected. Endoscopic endonasal transsphenoidal transsellar, transtuberculum-transplanum, and transcavernous approaches were performed by a neurosurgery trainee, under supervision from the senior authors and a PhD in anatomy with advanced neuroanatomy experience. Dissections were supplemented with representative case applications. Results Endoscopic endonasal transsphenoidal approaches afford excellent direct access to sellar and parasellar regions. After a wide sphenoidotomy, a limited sellar osteotomy opens the space to sellar region and medial portion of the cavernous sinus. To reach the suprasellar space (infrachiasmatic and suprachiasmatic corridors), a transplanum-prechiasmatic sulcus-transtuberculum adjunct is needed. The transcavernous approach gains access to the contents of the cavernous sinus and both medial (posterior clinoid and interpeduncular cistern) and lateral structures of the retrosellar region. Conclusion The anatomical understanding and technical skills required to confidently remove skull base lesions with EEAs are traditionally gained after years of specialized training. We comprehensively describe EEAs to sellar and parasellar regions for trainees to build knowledge and improve familiarity with these approaches and facilitate comprehension and learning in both the surgical anatomy laboratory and the operating room.
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Affiliation(s)
- Edoardo Agosti
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochester, Minnesota, United States
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - A. Yohan Alexander
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochester, Minnesota, United States
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Luciano C.P.C. Leonel
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochester, Minnesota, United States
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Jamie J. Van Gompel
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochester, Minnesota, United States
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Michael J. Link
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochester, Minnesota, United States
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Carlos D. Pinheiro-Neto
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochester, Minnesota, United States
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Maria Peris-Celda
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochester, Minnesota, United States
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
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Anatomical Variants, Pneumatization Classification, and Volumetric Studies of the Sphenoid Sinus With High-Resolution Computed Tomography. J Craniofac Surg 2021; 32:2542-2545. [PMID: 34705363 DOI: 10.1097/scs.0000000000007570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Aimed to explore the correlation between the volume of the sphenoid sinuses (SS) and sex, age, pneumatization and its anatomical variant types. MATERIAL AND METHODS Retrospectively evaluated high-resolution computed tomography images of 170 individuals; were studied by ITK-SNAP software to measure the volume of SS. RESULTS The average volume of SS was a significant difference between the gender, the volume of SS in the elderly group (≥65 years old) showed a downward trend. The volume of the SS in the variants of the anterior clinoid processes, pterygoid processes, greater wings, and clivus were significantly higher than in the nonvariants (P < 0.05). With the expansion of pneumatization, the optic nerve (CNII) type 3-4, the internal carotid artery (ICA) type 2-3 and the septal insertion on the ICA have a larger volume, while the occurrence of septal insertion on only the CNII was not correlated with the volume (P > 0.05). CONCLUSIONS AND SIGNIFICANCE The volume of SS is closely related to age, sex, the type of pneumatization and anatomical variation. High-resolution computed tomography can facilitate a precise study of anatomical variations and adjacent structures and help ensure the safety of an operation.
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Aibar-Durán JÁ, Muñoz-Hernández F, Asencio-Cortés C, Montserrat-Gili J, Gras-Cabrerizo JR, Mirapeix RM. Intracavernous Branches of the Internal Carotid Artery Through an Endoscopic Endonasal Approach: Anatomical Study and Review of the Literature. World Neurosurg 2021; 151:e332-e342. [PMID: 33887498 DOI: 10.1016/j.wneu.2021.04.046] [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: 03/22/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The endoscopic endonasal transcavernous (EET) approach is an increasingly popular approach for the cavernous sinus and surrounding structure lesions as well as a surgical corridor to pre-mesencephalic cisterns. This endoscopic study describes the main intracavernous branches of the internal carotid artery, providing nuances to improve the safety of this approach. MATERIAL AND METHODS Forty-six fresh cavernous sinus (23 heads) were injected with colored silicon and studied via an EET approach; 6 were excluded due to insufficient injection. The internal carotid artery, the meningohyphophyseal trunk (MHT) and its branches, and the inferolateral trunk were dissected, and branching patterns identified and classified. RESULTS The MHT was identified in 82.5% of cases. Two main MHT types were identified: complete, with 3 main branches, and incomplete, with fewer than 3. The main branches encountered were the inferior hypophyseal artery, present in 92.5% of cases, the dorsal meningeal artery (DMA), present in 87.5%, and the tentorial artery, present in 87.5%. The DMA was classified as prominent medial (48.6%), prominent lateral (20%), or bifurcation type (25.7%). Complete and incomplete MHT were further classified as complete MHT (A, B, and C) and incomplete MHT (A, B, C, and D) according to the combination of the different DMA types with other branches. The inferolateral trunk was a branch of the MHT in 7% of cases. CONCLUSIONS The MHT is a highly prevalent intracavernous branch, with 7 identifiable patterns based on DMA morphology and branch combination. This knowledge could guide surgeons in performing a safer EET approach.
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Affiliation(s)
- Juan Ángel Aibar-Durán
- Department of Neurosurgery, Santa Creu i Sant Pau Hospital, Barcelona, Spain; Human Anatomy Unit of the Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
| | | | | | | | | | - Rosa M Mirapeix
- Human Anatomy Unit of the Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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Hasanbelliu A, Andaluz N, Di Somma A, Keller JT, Zimmer LA, Samy RN, Pensak ML, Zuccarello M. Extended Anterior Petrosectomy Through the Transcranial Middle Fossa Approach and Extended Endoscopic Transsphenoidal-Transclival Approach: Qualitative and Quantitative Anatomic Analysis. World Neurosurg 2020; 138:e405-e412. [PMID: 32145421 DOI: 10.1016/j.wneu.2020.02.127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Petroclival tumors and ventrolateral lesions of the pons present unique surgical challenges. This cadaveric study provides qualitative and quantitative anatomic comparison for an anterior petrous apicectomy through the transcranial middle fossa (TMF) and expanded endoscopic transsphenoidal-transclival approaches. METHODS In 10 silicone-injected heads, the petrous apex and clivus were drilled extradurally using middle fossa and endonasal approaches. With in situ and frameless stereotactic navigation, we defined consistent points to compare working areas, bone removal volumes, approach angles, and surgical freedom. RESULTS Mean exposed TMF area (21.03 ± 3.46 cm2) achieved a 44.71 ± 4.13° working angle to the brainstem between cranial nerves V and VI. Kawase's rhomboid area measured 1.76 ± 0.34 cm2, and bone removal averaged 1.20 ± 0.12 cm3 at the petrous apex. Surgical freedom on the lateral brainstem was higher halfway between cranial nerves V and VI at the center of the rhomboid compared with midline at the basilar sulcus (P < 0.01). After clivectomy and petrous apicectomy, mean exposed expanded endoscopic transsphenoidal-transclival area was 5.29 ± 0.66 cm2. Approach from either nostril showed no statistically significant differences in surgical freedom at the foramen lacerum and midpoint basilar sulcus. At the petrous apex, bone volume removed and area exposed were significantly larger for the TMF approach (P < 0.001). CONCLUSIONS Expanded transclival anterior petrosectomy through the TMF approach provides an adequate corridor to lesions in the upper ventrolateral pons. The expanded endoscopic transsphenoidal-transclival approach better fits midline lesions not extending laterally beyond cranial nerve VI and C3 carotid when evaluating normal anatomic parameters.
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Affiliation(s)
- Aurel Hasanbelliu
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Norberto Andaluz
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Brain Tumor Center at University of Cincinnati Gardner Neuroscience Institute, Cincinnati, Ohio, USA; Mayfield Clinic, Cincinnati, Ohio, USA.
| | - Alberto Di Somma
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università; degli Studi di Napoli Federico II, Naples, Italy
| | - Jeffrey T Keller
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Brain Tumor Center at University of Cincinnati Gardner Neuroscience Institute, Cincinnati, Ohio, USA
| | - Lee A Zimmer
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Brain Tumor Center at University of Cincinnati Gardner Neuroscience Institute, Cincinnati, Ohio, USA; Mayfield Clinic, Cincinnati, Ohio, USA
| | - Ravi N Samy
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Brain Tumor Center at University of Cincinnati Gardner Neuroscience Institute, Cincinnati, Ohio, USA
| | - Myles L Pensak
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Brain Tumor Center at University of Cincinnati Gardner Neuroscience Institute, Cincinnati, Ohio, USA
| | - Mario Zuccarello
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Brain Tumor Center at University of Cincinnati Gardner Neuroscience Institute, Cincinnati, Ohio, USA
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Kournoutas I, Vigo V, Chae R, Wang M, Gurrola J, Abla AA, El-Sayed I, Rubio RR. Acquisition of Volumetric Models of Skull Base Anatomy Using Endoscopic Endonasal Approaches: 3D Scanning of Deep Corridors Via Photogrammetry. World Neurosurg 2019; 129:372-377. [PMID: 31181359 DOI: 10.1016/j.wneu.2019.05.251] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/30/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE In this study we aim to evaluate the feasibility of creating volumetric models of highly intricate skull-base anatomy-previously not amenable to volumetric reconstruction-using endoscopic endonasal approaches. METHODS Ten human cadaveric heads were dissected through the nasal corridor to expose anterior, middle, and posterior cranial fossi structures and the pterygopalatine and infratemporal fossi. A rigid endoscope with a 30° lens was used to capture the images. Subsequently, a photogrammetry software was used to align, smooth, and texturize the images into a complete 3-dimensional model. RESULTS An average of 174 photographs were used to construct each model (n = 10). In the end, we achieved high-definition stereoscopic volumetric models of the nasal corridor; paranasal fossae; and anterior, middle and posterior fossae structures that preserved structural integrity. Strategic points of interests were labeled and animated for educational use. CONCLUSIONS Endoscopic volumetric models represent a new way to depict the anatomy of the skull base; their use with 3-dimensional technologies could potentially improve the visuospatial understanding of narrow surgical corridors for education and surgical-planning purposes.
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Affiliation(s)
- Ioannis Kournoutas
- Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA
| | - Vera Vigo
- Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA; Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Ricky Chae
- Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA
| | - Minghao Wang
- Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA
| | - Jose Gurrola
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Adib A Abla
- Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA; Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Ivan El-Sayed
- Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA; Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Roberto Rodriguez Rubio
- Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA; Department of Neurological Surgery, University of California, San Francisco, California, USA; Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA.
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9
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Amin SM, Fathy H, Hussein A, Kamel M, Hegazy A, Fathy M. Endoscopic Endonasal Approach to the Lateral Wall of the Cavernous Sinus: A Cadaveric Feasibility Study. Ann Otol Rhinol Laryngol 2018; 127:903-911. [PMID: 30269513 DOI: 10.1177/0003489418803386] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE: A transcranial extradural approach to the middle cranial fossa (MCF) requires separation of the dural layers of the lateral wall of the cavernous sinus. The authors tested the feasibility of an endonasal approach for this separation. METHODS: A cadaveric feasibility study was conducted on the sides of 14 dry skulls and 10 fresh cadaveric heads. An endonasal, transsphenoidal, transpterygoid approach was taken to the MCF. The maxillary struts and medial greater wing of the sphenoid below the superior orbital fissure were drilled with transposition of the maxillary nerve. The lateral cavernous dural layers were split at the maxillary nerve with separation of the temporal lobe dura and exposure of the MCF bony base. The integrity of the cranial nerves and inner and outer dural layers of the lateral cavernous wall was checked. Different measurements of bony landmarks were obtained. RESULTS: The integrity of the dural layers of the lateral cavernous wall and the cranial nerves were preserved in 10 heads. The mean area of the bony corridor was 4.68 ± 0.97 cm2, the V2-to-V3 distance was 15.21 ± 3.36 mm medially and 18.21 ± 3.45 mm laterally, and the vidian canal length was 13.01 ± 3.06 mm. CONCLUSIONS: Endonasal endoscopic separation of the lateral cavernous dural layers is feasible without crossing the motor cranial nerves, allowing better exposure of the MCF.
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Affiliation(s)
- Sameh M Amin
- 1 Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Hesham Fathy
- 2 Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Hussein
- 2 Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Kamel
- 1 Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Ahmed Hegazy
- 2 Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Fathy
- 3 Al Azhar University Hospital, Cairo University, Cairo, Egypt
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Virtual Reality Model of the Three-Dimensional Anatomy of the Cavernous Sinus Based on a Cadaveric Image and Dissection. J Craniofac Surg 2018; 29:163-166. [DOI: 10.1097/scs.0000000000004046] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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11
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Gibelli D, Cellina M, Gibelli S, Oliva AG, Termine G, Sforza C. Anatomical variants of sphenoid sinuses pneumatisation: a CT scan study on a Northern Italian population. Radiol Med 2017; 122:575-580. [PMID: 28357538 DOI: 10.1007/s11547-017-0759-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 03/21/2017] [Indexed: 01/09/2023]
Abstract
Sphenoid bone may be affected by different variants of pneumatisation, which have a relevant importance from a clinical and surgical point of view. The description of such variants in different populations may give useful information. However, few articles describe the variability of sphenoid pneumatised structures and none of them focuses on Northern Italian population. Variants of pneumatisation of sphenoid bone were described in a sample of 300 Northern Italian patients who underwent a CT scan. More than fifty-seven percent of patients showed a form of anatomical variant: the most common form was the pneumatised pterygoid processes (39.6%), followed by dorsum sellae (32.9%) and clinoid processes (20.3%), without statistically significant differences between males and females (p > 0.01). In 26.3% of patients, a combined pneumatisation of these three structures was observed, being the combination pterygoid processes-dorsum sellae the most frequent (11.3%). In 9.3%, all the three sphenoid structures were affected. This article is the first description of the prevalence of different variants of pneumatisation in a Northern Italian population: the occurrence of such forms has to be acknowledged for their possible clinical and surgical consequences.
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Affiliation(s)
- Daniele Gibelli
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, V. Mangiagalli 31, Milan, Italy.
| | - Michaela Cellina
- Reparto di Radiologia, Ospedale Fatebenefratelli, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Stefano Gibelli
- Reparto di Otorinolaringoiatria, Ospedale Fatebenefratelli, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | - Giovanni Termine
- Reparto di Otorinolaringoiatria, Ospedale Fatebenefratelli, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Chiarella Sforza
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, V. Mangiagalli 31, Milan, Italy
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Matsuo S, Komune N, Iihara K, Rhoton AL. Translateral Orbital Wall Approach to the Orbit and Cavernous Sinus. Oper Neurosurg (Hagerstown) 2016; 12:360-373. [DOI: 10.1227/neu.0000000000001145] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/02/2015] [Indexed: 11/19/2022] Open
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13
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Morphological Characteristics of the Sphenoid Sinus and Endoscopic Localization of the Cavernous Sinus. J Craniofac Surg 2016. [PMID: 26221856 DOI: 10.1097/scs.0000000000001964] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The aim of this study was to investigate the relationship between the morphological characteristics of the sphenoid sinus and endoscopic localization of the cavernous sinus (CS) using an extended endoscopic endonasal transsphenoidal approach. Thirty sides of CS in 15 adult cadaver heads were dissected to simulate the extended endoscopic endonasal transsphenoidal approach, and the morphology of the sphenoid sinus and anatomic structures of CS were observed. The opticocarotid recess (OCR), ophthalmomaxillary recess (V1V2R), and maxillomandibular recess (V2V3R) in the lateral wall of the sphenoid sinus were presented in 16 sides (53.3%), 6 sides (20%), and 4 sides (13.3%) of the 30 sides, respectively. OCR is a constant anatomic landmark in endoscopy and coincides with the anterior portion of the clinoidal triangle. The C-shaped internal carotid artery (ICA) in the lateral wall of the sphenoid sinus was presented in 11 sides (36.7%), the upper one-third of which corresponds to the middle portion of the clinoidal triangle, and the lower two-thirds of which correlates to the supratrochlear triangle, infratrochlear triangle, and ophthalmic nerve in CS, around which the medial, lateral, and anteroinferior interspaces are distributed. From a front-to-behind perspective, the C-shaped ICA consists of inferior horizontal segment, anterior vertical segment, clinoidal segment as well as partial subarachnoid segment of the ICA. OCR and C-shaped ICA in the lateral wall of the sphenoid sinus are the 2 reliable anatomic landmarks in the intraoperative location of the parasellar region of CS.
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14
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Abuzayed B, Al-Abadi H, Al-Otti S, Baniyaseen K, Al-Sharki Y. Neuronavigation-guided endoscopic endonasal resection of extensive skull base mucormycosis complicated with cerebral vasospasm. J Craniofac Surg 2015; 25:1319-23. [PMID: 24902115 DOI: 10.1097/scs.0000000000000786] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A 24-year-old woman presented with double vision since 6 months. Examination revealed left eye ptosis and bilateral abducens nerve palsy. Brain computed tomographic scan and magnetic resonance imaging revealed a bone-eroding mass lesion located in the middle skull base, occupying the posterior ethmoidal cells, the planum sphenoidale, the sphenoid sinus, the lateral recesses of the sphenois sinus, the pterygoid apexes, and the middle and lower clivus, with compression of the inferior wall of the cavernous sinus and the parasellar and paraclival parts of the internal carotid artery. The patient was operated on with extended endoscopic endonasal approach guided with neuronavigation. Total mass resection was achieved. Histopathologic examination revealed mucormycosis infectious mass. On postoperative day 5, the patient developed right hemiplegia, and brain imaging revealed left internal carotid vasospasm. After treatment, the patient improved and was discharged.
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Affiliation(s)
- Bashar Abuzayed
- From the *Department of Neurosurgery, Al Bashir Government Hospital, Amman, Jordan; and Departments of †Neurosurgery, ‡Surgery, and §Pathology, Prince Hamza Hospital, Amman, Jordan
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15
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Felippu A, Mora R, Guastini L, Peretti G. Transnasal Approach to the Orbital Apex and Cavernous Sinus. Ann Otol Rhinol Laryngol 2013; 122:254-62. [DOI: 10.1177/000348941312200407] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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16
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Wirth LJ, Plotkin SR, Emerick KS, Cunnane ME, Faquin WC. Case records of the Massachusetts General Hospital. Case 29-2012. A 49-year-old man with pain and cranial-nerve palsies after treatment of oral cancer. N Engl J Med 2012; 367:1136-47. [PMID: 22992078 DOI: 10.1056/nejmcpc1104565] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Lori J Wirth
- Department of Medical Oncology, Massachusetts General Hospital, Boston, USA
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17
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Salma A, Baidya NB, Wendt B, Aguila F, Sammet S, Ammirati M. Qualitative and quantitative radio-anatomical variation of the posterior clinoid process. Skull Base 2012; 21:373-8. [PMID: 22547963 DOI: 10.1055/s-0031-1287678] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This study was conducted to investigate the radiological anatomy of the posterior clinoid process (PCP) to highlight preoperative awareness of its variations and its relationships to other skull base landmarks. The PCPs of 36, three-dimensional computed tomographic cadaveric heads were evaluated by studying the gross anatomy of the PCP and by measuring the distances between the PCP and other skull base anatomical landmarks relevant to transnasal or transcranial skull base approaches. PCP variations were found in five specimens (14%): in two the dorsum sellae was absent, in one the PCP and the anterior clinoid process (ACP) were connected unilaterally and in two bilaterally. The mean distance between the right/left PCP and the crista galli was 45.14 ± 4.0 standard deviation (SD_/46.24 ± 4.5 SD, respectively, while the distance to the middle point of the basion at the level of the foramen magnum was 40.41 ± 5.1 SD/41.0 ± 5.2 SD, respectively. The mean distance between the PCP and the ACP was 12.03 ± 3.18 SD on the right side and 12.11 ± 2.77 SD on the left. The data provided highlights the importance of careful preoperative evaluation of the PCP and of its relationships to other commonly encountered skull base landmarks. This information may give an idea of the exposure achievable through different transcranial and transnasal approaches. This is especially relevant when neuronavigation is not available.
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18
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Ceylan S, Anik I, Koc K, Kokturk S, Ceylan S, Cine N, Savli H, Sirin G, Sam B, Gazioglu N. Microsurgical anatomy of membranous layers of the pituitary gland and the expression of extracellular matrix collagenous proteins. Acta Neurochir (Wien) 2011; 153:2435-43; discussion 2443. [PMID: 21969225 DOI: 10.1007/s00701-011-1182-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 09/20/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND There are several reports about the microanatomical and histological features of sellar and parasellar membranous structures and clinical studies about MMP proteinase as a predictive factor. However, studies on collagen contents of sellar and parasellar membranous structures are limited. We demonstrated the membranous structures surrounding the pituitary gland and defined extracellular matrix (ECM) collagenous proteins, collagen I-IV expression patterns of sellar and parasellar connective tissues. METHODS The study was carried out on ten fresh postmortem human bodies at the Forensic Medicine Institution. Cavernous sinuses were resected with sellar structures and were stored at -80°C liquid nitrogen tanks. Medial wall of the cavernous sinus, pituitary capsule and pituitary tissue samples were obtained for RT-PCR. Opposite side specimens were used for histological and immune staining studies. Collagens I-IV were studied by immunohistochemical and reverse transcription polymerase chain reaction (RT-PCR) methods. FINDINGS The pituitary capsule and medial wall were identified as two different structures. The fibrous membrane, as the third membrane, was identified as staying whole in eight of ten specimens. Increased type IV collagen was determined in the pituitary gland, medial wall and pituitary capsule, respectively, in both RT-PCR and immunhistochemical studies. Immunhistochemical studies revealed that collagen I was strongly expressed in both the medial wall and pituitary gland. CONCLUSION Increased type IV collagen was detected especially in pituitary tissue, the medial wall and the pituitary capsule by immune staining and RT-PCR. Type IV collagen was considered to be an important factor in the progression of adenoma and invasion.
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Affiliation(s)
- Savas Ceylan
- Pituitary Research Centre, Kocaeli University, Kocaeli, Turkey.
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Lu Y, Pan J, Qi S, Shi J, Zhang X, Wu K. Pneumatization of the sphenoid sinus in Chinese: the differences from Caucasian and its application in the extended transsphenoidal approach. J Anat 2011; 219:132-42. [PMID: 21517841 DOI: 10.1111/j.1469-7580.2011.01380.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
In recent years, the transsphenoidal approach has been extensively used surgically to treat parasellar, suprasellar, clival, and even petrous lesions. Extended pneumatization of the sphenoid sinus (SS) is considered an indispensable element for the extended transsphenoidal (ETS) approach. Because most anatomical studies of the ETS approach use Caucasian subjects, the present study aims to clarify the pneumatic extension types in Chinese individuals as well as any differences from those in Caucasians and analyze these differences with respect to the application of the ETS approach. A total of 200 computed tomography (CT) images of SSs and 18 adult cadaveric heads were selected for observation and measurement. The conchal, presellar, and sellar types comprised 6, 28.5, and 65.5% of subjects, respectively; according to the extra extension, the prevalence of the lateral, clival, lesser wing, and combined extension sinus types was 11.4, 21.4, 0.8, and 48.1% of subjects, respectively. The percentages of pneumatization of the anterior and posterior clinoid processes, pterygoid process, and optic strut were 5.0, 1.0, 22.3, and 7.0%, respectively. Onodi cells were observed in 61.1% of the sides of the cadaveric heads, including 30.6% with good pneumatization with identifiable optical or ICA bulges. These features were related to poor lateral and clival gasification in Chinese compared with Caucasians, which might make extended surgery more dangerous. However, the anterior pneumatization, especially the higher presentation of Onodi cells, ensures that the anterior ETS approach can be performed safely in Chinese patients. In general, measurements showing smaller sinus volumes and thicker bones with identifiable bone landmarks that are hard to find compared with those in Caucasians suggest increased surgical risks in the Chinese population. In this situation, carefully analysis of presurgical CT and magnetic resonance imaging scans is important. Furthermore, in the ETS approach, the use of stricter intraoperative technological devices such as neuronavigation and ultrasound Doppler is advisable.
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Affiliation(s)
- Yuntao Lu
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangdong, China
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Extended endoscopic endonasal approach to the suprasellar parachiasmatic cisterns: anatomic study. Childs Nerv Syst 2010; 26:1161-70. [PMID: 20567834 DOI: 10.1007/s00381-010-1204-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Accepted: 06/12/2010] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The objective of this study is to recognize the available endoscopic routes during approaches to the suprasellar region and the surgical endoscopic anatomy of the related neurovascular structures. MATERIAL AND METHODS Extended endoscopic endonasal approach to the suprasellar region (EEASR) through the planum sphenoidale was performed in five fresh adult cadavers. The anatomic characteristics of the suprasellar parachiasmatic cisterns were studied and documented following the resection of the planum sphenoidale and opening the dura to expose the anterior incisural space. RESULTS Two separate surgical corridors could be used during EEASR: one above and the other below the chiasm. The suprachiasmatic route exposed the gyrus recti, interhemispheric fissure, anterior cerebral artery complex, the lamina terminalis, and through this structure the anterior recess of the third ventricle. The subchiasmatic route exposed the pituitary stalk, superior hypophyseal artery, supraclinoidal internal carotid artery, origin of the ophthalmic artery, anterior choroidal artery, posterior communicating artery, uncus, optic tract, basilar artery and its bifurcation, pons, posterior cerebral artery, superior cerebellar artery, and oculomotor nerve. CONCLUSION The EEASR, a minimally invasive route to suprasellar parachiasmatic area, provided wide exposure of the basal cisterns. The surgical areas that were accessed through the subchiasmatic corridor could be divided into a medial part that included the interpeduncular and prepontine cisterns and a lateral part that contained carotid and sylvian cisterns superiorly and the crural and ambient cisterns inferiorly.
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