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The importance of preserving the superior hypophyseal artery infundibular branch in craniopharyngioma surgery. Acta Neurochir (Wien) 2023; 165:667-675. [PMID: 36355231 DOI: 10.1007/s00701-022-05415-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE Postoperative pituitary dysfunction, a critical problem in the treatment of craniopharyngiomas, can occur even when the pituitary stalk is preserved. We hypothesized that compromise of the primary superior hypophyseal artery (pSHA) might be related to this occurrence. METHODS We performed a retrospective review of 131 patients with craniopharyngioma who underwent surgery from April 2009 to September 2021. The inclusion criteria were initial surgery, endoscopic transsphenoidal surgery, preoperative normal pituitary function or pituitary dysfunction in one axis, and morphological preservation of the pituitary stalk. The branches of the pSHA consist mainly of the chiasmatic branches (Cb), infundibular branches (Ib), and descending branches (Db). We analyzed the association between postoperative pituitary function and preservation of these branches. RESULTS Twenty patients met the criteria. Preoperative anterior pituitary function was normal in 18 patients, and there was isolated growth hormone deficiency in two patients. No patient had preoperative diabetes insipidus (DI). Anterior pituitary function was unchanged postoperatively in eight patients. Of these eight patients, bilateral preservation of pSHA Ib was confirmed in seven patients. Bilateral preservation of pSHA Ib was the only factor associated with preserved anterior pituitary function (p < 0.01). Fifteen patients were free of permanent DI, and the preservation of any given pSHA branch produced no significant difference in the postoperative occurrence of permanent DI. CONCLUSIONS Our study shows that bilateral preservation of pSHA Ib provides favorable postoperative anterior pituitary function in craniopharyngioma surgery; however, such preservation may have little effect on the postoperative occurrence of DI.
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Zhang H, Zhang S, Shang M, Wang J, Wei L, Wang S. Pituitary stalk changes on magnetic resonance imaging following pituitary adenoma resection using a transsphenoidal approach. Front Neurol 2023; 14:1049577. [PMID: 36779061 PMCID: PMC9911825 DOI: 10.3389/fneur.2023.1049577] [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: 09/20/2022] [Accepted: 01/04/2023] [Indexed: 01/28/2023] Open
Abstract
Objective We aimed to investigate the magnetic resonance imaging (MRI) findings and clinical significance of position and changes in morphology of the pituitary stalk following pituitary adenoma (PA) resection using a transsphenoidal approach. Methods We collected clinical and MRI data of 108 patients with PA after transsphenoidal surgery. Diameter, length, and coronal deviation of the pituitary stalk were measured pre-, post-, and mid-term post-operatively, to observe pituitary stalk morphology. Results Of 108 patients, 53 pituitary stalks were recognisable pre-operatively. The angle between the pituitary stalk and the median line was 7.22°-50.20° (average, 25.85°) in 22 patients with left-sided pituitary stalks and 5.32°-64.05° (average, 21.63°) in 20 patients with right-sided pituitary stalks. Of 42 patients with preoperative pituitary stalk deviation, 41 had an early postoperative recovery and 1 had increased deviation. In the mid-term postoperative period, 21 of 42 patients had pituitary stalks located centrally. In 53 patients, the pituitary stalk length was 1.41-11.74 mm (mean, 6.12 mm) pre-operatively, 3.61-11.63 mm (mean, 6.93 mm) in the early postoperative period, and 5.37-17.57 mm (mean, 8.83 mm) in the mid-term postoperative period. In the early postoperative period, 58 (53.70%) patients had posterior pituitary bright spots (PPBS) and 28 (25.92%) had diabetes insipidus (DI). Conclusion Pre-operatively, the pituitary stalk was compressed and thinned. Post-operatively, it could be stretched to a "normal state", and its position showed a gradual centring trend. Post-operatively, the length of the pituitary stalk gradually increased. The PPBS in the early postoperative period negatively correlated with postoperative DI.
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Affiliation(s)
- Huijian Zhang
- Department of Neurosurgery, 900th Hospital of Joint Logistic Support Force, Fuzhou, Fujian, China
| | - Shuai Zhang
- Department of Neurosurgery, Huanggang Central Hospital, Huanggang, Hubei, China
| | - Mingchao Shang
- Department of Neurosurgery, 900th Hospital of Joint Logistic Support Force, Fuzhou, Fujian, China
| | - Jiaxing Wang
- Department of Neurosurgery, 900th Hospital of Joint Logistic Support Force, Fuzhou, Fujian, China
| | - Liangfeng Wei
- Department of Neurosurgery, 900th Hospital of Joint Logistic Support Force, Fuzhou, Fujian, China
| | - Shousen Wang
- Department of Neurosurgery, 900th Hospital of Joint Logistic Support Force, Fuzhou, Fujian, China,Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China,*Correspondence: Shousen Wang ✉
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Developed Circuminfundibular Anastomosis Associated with Vascular Abnormalities. World Neurosurg 2022; 166:130-134. [PMID: 35940505 DOI: 10.1016/j.wneu.2022.07.089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 12/15/2022]
Abstract
We report a 74-year-old male patient who presented with left hemiplegia and disturbance of consciousness. Computed tomography revealed diffuse subarachnoid hemorrhage, which was prominent in the right Sylvian and basal cisterns. Digital subtraction angiography revealed absence of the C2 segment of the right internal carotid artery (ICA) and a significantly developed circuminfundibular anastomosis. Occlusion of the bilateral vertebral arteries (VAs) was also seen. The upper basilar artery was supplied by the circuminfundibular anastomosis and collaterals from the VAs. Since the source of bleeding was unclear, the patient was treated conservatively. Circuminfundibular anastomosis is a potential anastomosis around the pituitary stalk. It is formed by the superior hypophyseal arteries, prechiasmal arteries, and infundibular arteries bilaterally. Agenesis of the contralateral ICA often leads to development of ICA-ICA anastomoses. In this case, the anastomosis developed due to agenesis of the C2 segment of the right ICA and occlusion of the bilateral VAs.
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Sahin B, Aydin SO, Yilmaz MO, Saygi T, Hanalioglu S, Akyoldas G, Baran O, Kiris T. Contralateral vs. Ipsilateral Approach to Superior Hypophyseal Artery Aneurysms: An Anatomical Study and Morphometric Analysis. Front Surg 2022; 9:915310. [PMID: 35693307 PMCID: PMC9174940 DOI: 10.3389/fsurg.2022.915310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/03/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Surgical clipping of superior hypophyseal artery (SHA) aneurysms is a challenging task for neurosurgeons due to their close anatomical relationships. The development of endovascular techniques and the difficulty in surgery have led to a decrease in the number of surgical procedures and thus the experience of neurosurgeons in this region. In this study, we aimed to reveal the microsurgical anatomy of the ipsilateral and contralateral approaches to SHA aneurysms and define their limitations via morphometric analyses of radiological anatomy, three-dimensional (3D) modeling, and surgical illustrations. Method Five fixed and injected cadaver heads underwent dissections. In order to make morphometric measurements, 75 cranial MRI scans were reviewed. Cranial scans were rendered with a module and used to produce 3D models of different anatomical structures. In addition, a medical illustration was drawn that shows different sizes of aneurysms and surgical clipping approaches. Results For the contralateral approach, pterional craniotomy and sylvian dissection were performed. The contralateral SHA was reached from the prechiasmatic area. The dissected SHA was approached with an aneurysm clip, and maneuverability was evaluated. For the ipsilateral approach, pterional craniotomy and sylvian dissection were performed. The ipsilateral SHA was reached by mobilizing the left optic nerve with left optic nerve unroofing and left anterior clinoidectomy. MRI measurements showed that the area of the prechiasm was 90.4 ± 36.6 mm2 (prefixed: 46.9 ± 10.4 mm2, normofixed: 84.8 ± 15.7 mm2, postfixed: 137.2 ± 19.5 mm2, p < 0.001), the distance between the anterior aspect of the optic chiasm and the limbus sphenoidale was 10.0 ± 3.5 mm (prefixed: 5.7 ± 0.8 mm, normofixed: 9.6 ± 1.6 mm, postfixed:14.4 ± 1.6 mm, p < 0.001), and optic nerves’ interneural angle was 65.2° ± 10.0° (prefixed: 77.1° ± 7.3, normofixed: 63.6° ± 7.7°, postfixed: 57.7° ± 5.7°, p: 0.010). Conclusion Anatomic dissections along with 3D virtual model simulations and illustrations demonstrated that the contralateral approach would potentially allow for proximal control and neck control/clipping in smaller SHA aneurysm with relatively minimal retraction of the contralateral optic nerve in the setting of pre- or normofixed chiasm, and ipsilateral approach requires anterior clinodectomy and optic unroofing with considerable optic nerve mobilization to control proximal ICA and clip the aneurysm neck effectively.
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Affiliation(s)
- Balkan Sahin
- Microsurgical Neuroanatomy Laboratory, Koc University Hospital, Istanbul, Turkey
| | - Serdar Onur Aydin
- Microsurgical Neuroanatomy Laboratory, Koc University Hospital, Istanbul, Turkey
| | - Mehmet Ozgur Yilmaz
- Microsurgical Neuroanatomy Laboratory, Koc University Hospital, Istanbul, Turkey
| | - Tahsin Saygi
- Microsurgical Neuroanatomy Laboratory, Koc University Hospital, Istanbul, Turkey
| | - Sahin Hanalioglu
- Department of Neurosurgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Goktug Akyoldas
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
| | - Oguz Baran
- Microsurgical Neuroanatomy Laboratory, Koc University Hospital, Istanbul, Turkey
- Department of Neurosurgery, Koc University Hospital, Istanbul, Turkey
- Correspondence: Oguz Baran
| | - Talat Kiris
- Department of Neurosurgery, American Hospital, Istanbul, Turkey
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Ogawa Y, Sato K, Endo T, Tominaga T. Quantification of Tumor Blush of Highly Vascularized Tumors with Slow Feeding System: Representative Use for Giant Pituitary Adenomas. J Neurol Surg A Cent Eur Neurosurg 2021; 83:110-117. [PMID: 34897617 DOI: 10.1055/s-0040-1721014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Modern imaging techniques can identify adverse factors for tumor removal such as cavernous sinus invasion before surgery, but surgeries for giant pituitary adenomas often reveal discrepancies between preoperative imaging and intraoperative findings because pituitary adenomas have feeding arteries with narrow diameters. Current imaging methods are not suitable for tumors with not only large vascular beds but also slow arterial filling. PATIENTS AND METHODS This prospective study recruited 13 male subjects and 9 female subjects with giant pituitary adenomas between November 2011 and 2018. All the patients were investigated with three-dimensional magnetic resonance (MR) imaging, bone image computerized tomography (CT), and digital subtraction angiography (DSA) using a C-arm cone-beam CT scanner with a flat-panel detector and 50% diluted contrast medium. Fine angioarchitecture was evaluated and the tumor blush was quantified using newly developed region of interest (ROI) analysis to establish surgical strategies. RESULTS Seven patients demonstrated no or very faint tumor blushes. In these patients, feeding arteries run centripetally from the surface of the tumor. Fifteen patients showed significant tumor blushes, and the feeding arteries penetrated centrifugally from the inferoposterior pole to the upper pole of the tumor. All the patients were treated according to the angiographic information with successful hemostasis. The patients showed improvement and/or disappearance of the neurologic deficits. The faint and significant blush groups showed significant differences in intraoperative bleeding (p < 0.01) and operation time (p < 0.05). CONCLUSION Specialized evaluation focused on vascularization is required for successful therapy of giant pituitary adenomas.
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Affiliation(s)
- Yoshikazu Ogawa
- Department of Neurosurgery, Kohnan Hospital, Taihaku-ku, Sendai, Japan
| | - Kenichi Sato
- Department of Neuroendovascular Therapy, Kohnan Hospital, Taihaku-ku, Sendai, Japan
| | - Toshiki Endo
- Department of Neurosurgery, Tohoku University, Aoba, Sendai, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Graduate School of Medicine, Tohoku University, Aoba, Sendai, Japan
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Cironi KA, Decater T, Iwanaga J, Dumont AS, Tubbs RS. Arterial Supply to the Pituitary Gland: A Comprehensive Review. World Neurosurg 2020; 142:206-211. [PMID: 32634634 DOI: 10.1016/j.wneu.2020.06.221] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/26/2020] [Accepted: 06/28/2020] [Indexed: 10/23/2022]
Abstract
Knowledge of the blood supply to the pituitary gland is important for clinicians and surgeons. Therefore, a good working knowledge of this anatomy is important. The goal of this article was to review current anatomic knowledge of the blood supply to the pituitary gland and its clinical relevance.
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Affiliation(s)
- Katherine A Cironi
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Tess Decater
- Department of Anatomical Sciences, St. George's University, Grenada, West Indies
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, 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; Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurosurgery, Ochsner Health System, New Orleans, Louisiana, USA; Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA; Department of Anatomical Sciences, St. George's University, Grenada, West Indies
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Truong HQ, Najera E, Zanabria-Ortiz R, Celtikci E, Sun X, Borghei-Razavi H, Gardner PA, Fernandez-Miranda JC. Surgical anatomy of the superior hypophyseal artery and its relevance for endoscopic endonasal surgery. J Neurosurg 2019; 131:154-162. [PMID: 30004277 DOI: 10.3171/2018.2.jns172959] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 02/02/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The endoscopic endonasal approach has become a routine corridor to the suprasellar region. The superior hypophyseal arteries (SHAs) are intimately related to lesions in the suprasellar space, such as craniopharyngiomas and meningiomas. Here the authors investigate the surgical anatomy and variations of the SHA from the endoscopic endonasal perspective. METHODS Thirty anatomical specimens with vascular injection were used for endoscopic endonasal dissection. The number of SHAs and their origin, course, branching, anastomoses, and areas of supply were collected and analyzed. RESULTS A total of 110 SHAs arising from 60 internal carotid arteries (ICAs), or 1.83 SHAs per ICA (range 0-3), were found. The most proximal SHA always ran in the preinfundibular space and provided the major blood supply to the infundibulum, optic chiasm, and proximal optic nerve; it was defined as the primary SHA (pSHA). The more distal SHA(s), present in 78.3% of sides, ran in the retroinfundibular space and supplied the stalk and may also supply the tuber cinereum and optic tracts. In the two sides (3.3%) in which no SHA was present, the territory was covered by a pair of infundibular arteries originating from the posterior communicating artery. Two-thirds of the pSHAs originated proximal to the distal dural ring; half of these arose from the carotid cave portion of the ICA, whereas the other half originated proximal to the cave. Four branching patterns of the pSHA were recognized, with the most common pattern (41.7%) consisting of three or more branches with a tree-like pattern. Descending branches were absent in 25% of cases. Preinfundibular anastomoses between pSHAs were found in all specimens. Anastomoses between the pSHA and the secondary SHA (sSHA) or the infundibular arteries were found in 75% cases. CONCLUSIONS The first SHA almost always supplies the infundibulum, optic chiasm, and proximal optic nerve and represents the pSHA. Compromising this artery can cause a visual deficit. Unilateral injury to the pSHA is less likely to cause an endocrine deficit given the artery's abundant anastomoses. A detailed understanding of the surgical anatomy of the SHA and its many variations may help surgeons when approaching challenging lesions in the suprasellar region.
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Nagm A, Horiuchi T, Hongo K. Letter to the Editor. Endoscopic endonasal surgery and the superior hypophyseal artery: further studies remain mandatory. J Neurosurg 2019; 131:329-331. [PMID: 30544361 DOI: 10.3171/2018.9.jns182513] [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]
Affiliation(s)
- Alhusain Nagm
- 1Shinshu University School of Medicine, Matsumoto, Japan; and
- 2Al-Azhar University Faculty of Medicine-Nasr City, Cairo, Egypt
| | | | - Kazuhiro Hongo
- 1Shinshu University School of Medicine, Matsumoto, Japan; and
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Doglietto F, Prevedello DMS, Belotti F, Ferrari M, Lancini D, Schreiber A, Raffetti E, La Rocca G, Rigante M, Lauretti L, Hirtler L, Buffoli B, Nicolai P, Fontanella MM, Rodella L, Gentili F, Tschabitscher M. The Superior Hypophyseal Arteries: Anatomical Study with an Endoscopic Endonasal Perspective. Oper Neurosurg (Hagerstown) 2019; 17:321-331. [DOI: 10.1093/ons/opy393] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 12/14/2018] [Indexed: 12/14/2022] Open
Abstract
AbstractBACKGROUNDThe use of high-definition endoscopes in extended transsphenoidal approaches to the suprasellar area has significantly improved visualization of its vascularization.OBJECTIVETo systematically examine the superior hypophyseal arteries (SHAs) anatomy from an endonasal endoscopic perspective.METHODSThe endoscopic endonasal transsphenoidal trans-tuberculum approach was performed in 19 adult, fresh and latex injected specimens. Dissections recordings were reviewed to analyze SHAs type, number, and branches, as well as internal carotid arteries (ICA) branches that vascularized optic nerves and chiasm.RESULTSIdentification of SHAs was possible in all specimens (37/38 sides). The number of SHAs varied from 1 to 3 per side (mean: 1.7). The anterior superior hypophyseal artery was visible in almost all cases (35/37 sides) and originated at the level of the carotid cave in 18/35 specimens; number of branches ranged from 1 to 6 (mean: 3.5), directed to the optic nerve (86%), chiasm (57%), infundibulum (86%), and/or parallel to the pituitary stalk (74%). The 4 main branches and patterns, originally described by McConnell in 1953, were confirmed. The posterior superior hypophyseal artery was evident in 28/37 sides with number of branches ranging from 0 to 4 (mean: 2.1), directed to the optic chiasm (50%), optic tract (32%), infundibulum (79%), and/or pituitary stalk (36%). The surgical implications of this study, together with anatomical and clinical videos, are also briefly discussed.CONCLUSIONSHAs constitute a complex of anterior and posterior branches that stem from the medial ICA with different patterns, vascularizing the optic apparatus and pituitary stalk.
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Affiliation(s)
- Francesco Doglietto
- Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Daniel Monte-Serrat Prevedello
- Department of Neurological Surgery, Wexner Medical Centre, The Ohio State University College of Medicine, Columbus, Ohio
| | - Francesco Belotti
- Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marco Ferrari
- Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Davide Lancini
- Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Alberto Schreiber
- 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 Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | | | - Mario Rigante
- Otorhinolaryngology, Catholic University School of Medicine, Rome, Italy
| | | | - Lena Hirtler
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Barbara Buffoli
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Piero Nicolai
- Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marco Maria Fontanella
- Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Luigi Rodella
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Fred Gentili
- Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Manfred Tschabitscher
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Ogawa Y, Sato K, Matsumoto Y, Tominaga T. Evaluation of Fine Feeding System and Angioarchitecture of Giant Pituitary Adenoma—Implications for Establishment of Surgical Strategy. World Neurosurg 2016; 85:244-51. [DOI: 10.1016/j.wneu.2015.09.087] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/25/2015] [Accepted: 09/25/2015] [Indexed: 11/17/2022]
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Horiuchi T, Goto T, Tanaka Y, Kodama K, Tsutsumi K, Ito K, Hongo K. Role of superior hypophyseal artery in visual function impairment after paraclinoid carotid artery aneurysm surgery. J Neurosurg 2015; 123:460-6. [PMID: 25699410 DOI: 10.3171/2014.12.jns141218] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Although a number of studies have assessed the surgical treatment of paraclinoid-segment carotid artery aneurysms and resulting visual complications, less attention has been given to the results with respect to the superior hypophyseal artery (SHA). The authors evaluated the relationship between the aneurysm, the SHA itself, and postoperative visual function in patients with ruptured and unruptured SHA aneurysms. METHODS From January 1991 through December 2013, 181 patients with 190 paraclinoid carotid artery aneurysms received treatment at Shinshu University Hospital and its affiliated hospitals. The authors retrospectively analyzed charts, operative records, operative videos, and neuroimaging findings for these patients with or without postoperative visual complications. RESULTS The authors identified 72 SHA aneurysms in 70 patients (mean age 58 years). Of 69 patients (1 patient died) evaluated, postoperative visual complications occurred in 9 (13.0%). Although the aneurysm size and SHA sacrifice did not lead to postoperative visual impairment, simultaneous treatment of bilateral aneurysms was a risk factor for postoperative visual complications. CONCLUSIONS Unilateral SHA impairment may be safe (i.e., it may not induce ischemia of the optic pathway) for many, but not all, patients with SHA aneurysm.
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Affiliation(s)
- Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto; and
| | - Tetsuya Goto
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto; and
| | - Yuichiro Tanaka
- Department of Neurosurgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kunihiko Kodama
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto; and
| | - Keiji Tsutsumi
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto; and
| | - Kiyoshi Ito
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto; and
| | - Kazuhiro Hongo
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto; and
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Musleh W, Sonabend AM, Lesniak MS. Role of craniotomy in the management of pituitary adenomas and sellar/parasellar tumors. Expert Rev Anticancer Ther 2014; 6 Suppl 9:S79-83. [PMID: 17004861 DOI: 10.1586/14737140.6.9s.s79] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The transphenoidal procedure has become the preferred approach in the surgical management of sellar/parasellar tumors. Nevertheless, specific indications remain for the transcranial approach and the objective of this review is to evaluate the available data on outcomes following transcranial or transphenoidal approaches to sellar/parasellar tumors. We assess the indications used for each approach and parameters that favor one over the other. Factors such as tumor size, consistency and configuration are important variables in choosing the transcranial approach. Other important considerations include persistent visual loss after incomplete decompression via the transphenoidal route, ectatic midline carotid arteries, co-existent intracranial aneurysms and sphenoid sinusitis. We review the data on visual and endocrinological outcomes following the transcranial or transphenoidal approach and provide an argument that, while there appears to be a trend towards greater visual improvement after transcranial surgery for large-to-giant pituitary adenomas, this benefit is offset by a greater risk of postoperative pituitary dysfunction. There is no difference in the rate of recurrence between the two procedures in the published literature. Overall, craniotomies will continue to play a role in the management of patients with sellar/parasellar tumors, although patient selection and careful preoperative evaluation are key elements in choosing the most appropriate approach.
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Affiliation(s)
- Wael Musleh
- The University of Chicago, Division of Neurosurgery, Chicago, IL 60637, USA
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Johnson JN, Elhammady M, Post J, Pasol J, Ebersole K, Aziz-Sultan MA. Optic pathway infarct after Onyx HD 500 aneurysm embolization: visual pathway ischemia from superior hypophyseal artery occlusion. J Neurointerv Surg 2013; 6:e47. [PMID: 24362967 DOI: 10.1136/neurintsurg-2013-010968.rep] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We report a case of visual deterioration after Onyx HD 500 embolization of a left 7 mm superior hypophyseal artery (SHA) aneurysm. After the procedure, the patient experienced a right incongruous homonymous hemianopia, and MRI showed an infarct of the ipsilateral optic chiasm/tract but no evidence of aneurysm mass effect or embolic cortical infarcts. The optic pathway ischemia is believed to be secondary to Onyx penetration and occlusion of an SHA branch near the aneurysm neck. Caution is advised when using liquid embolic agents to treat SHA aneurysms as SHA occlusion may lead to visual deficits.
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Affiliation(s)
| | - Mohamed Elhammady
- Department of Neurosurgery, University of Miami, Miami, Florida, USA
| | - Judith Post
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joshua Pasol
- Department of Neuroradiology, University of Miami, Miami, Florida, USA
| | - Koji Ebersole
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
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Johnson JN, Elhammady M, Post J, Pasol J, Ebersole K, Aziz-Sultan MA. Optic pathway infarct after Onyx HD 500 aneurysm embolization: visual pathway ischemia from superior hypophyseal artery occlusion. BMJ Case Rep 2013; 2013:bcr2013010968. [PMID: 24347448 PMCID: PMC3888536 DOI: 10.1136/bcr-2013-010968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of visual deterioration after Onyx HD 500 embolization of a left 7 mm superior hypophyseal artery (SHA) aneurysm. After the procedure, the patient experienced a right incongruous homonymous hemianopia, and MRI showed an infarct of the ipsilateral optic chiasm/tract but no evidence of aneurysm mass effect or embolic cortical infarcts. The optic pathway ischemia is believed to be secondary to Onyx penetration and occlusion of an SHA branch near the aneurysm neck. Caution is advised when using liquid embolic agents to treat SHA aneurysms as SHA occlusion may lead to visual deficits.
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Gabrovsky S, Laleva M, Gabrovsky N. The premamillary artery--a microanatomical study. Acta Neurochir (Wien) 2010; 152:2183-9. [PMID: 20700746 DOI: 10.1007/s00701-010-0763-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Accepted: 07/30/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND The microanatomical parameters of the premamillary artery (PMA) for the different configurations of the posterior communicating artery-adult (aPComA), hypoplastic (hPComA) and foetal (fPComA) were assessed and analysed. A comparative study with relevance to the neurosurgical practice has been carried out. METHOD Red-coloured latex was injected in 35 human cadaver brains and a microanatomical dissection was performed. The area of emergence, the diameter, the length and the zone of penetration of the PMA were accessed. RESULTS Seventy PComA were found and 96 PMA were identified. In more than 85% of the cases, the diameter of the PMA largely surpassed the diameter of the other perforating vessels. In the aPComA group, the PMA was a single branch in 72.4% of the cases with mean diameter of 0.52 mm and average length of 13.22 mm. PMA was found to originate from the middle third in 60.5%. For the hPComA group, in 66.7% of the cases, one PMA with mean diameter of 0.49 mm and average length 12.41 mm was found. In 60.9%, PMA originated from the middle third. For the fPComA group, in 50.0% of the cases, one PMA was found with mean diameter of 0.39 mm, average length of 12.42 mm. PMA was found to originate from the anterior third in 41.7% of the cases. Emergence of the PMA from the internal carotid artery and from the P2 segment of the posterior cerebral artery was also documented. CONCLUSION For the aPComA and the hPComA groups, the typical PMA may be described as the largest and most constant perforating branch emerging from the anterior 2/3 of the PComA and reaching the paramedian perforate substance. The PMA of the fPComA generally conforms to these characteristics but it is usually thinner, frequently duplicated and with higher percent of atypical emergence. These anatomical peculiarities may facilitate the intraoperative identification and preservation of the PMA when dealing with vascular or neoplastic pathologies with parasellar or interpeduncular extension.
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16
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Wang Q, Chen C, Song D, Leng B. Transarterial embolization of traumatic carotid-superior hypophyseal arterial cavernous fistula. A case report. Interv Neuroradiol 2010; 16:278-81. [PMID: 20977860 DOI: 10.1177/159101991001600308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Accepted: 07/18/2010] [Indexed: 11/15/2022] Open
Abstract
A 26-year-old man presented with symptoms of progressive bilateral exophthalmos and swelling of the eyelids after a severe head injury. Angiography confirmed a direct carotid-superior hypophyseal arterial (SHA) cavernous fistula with petrosal sinus and intracavernous sinus drainage. Successful transarterial coil embolization of the fistula was performed with resolution of the patient's symptoms. To our knowledge, post-traumatic arteriovenous fistula between SHA and the cavernous sinus has not been previously reported. We hereby demonstrate an effective, minimally invasive method of occluding a rare fistula by transarterial embolization.
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Affiliation(s)
- Q Wang
- Department of Neurosurgery, Fudan University, Shanghai, China.
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17
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Microneurosurgical management of internal carotid artery bifurcation aneurysms. ACTA ACUST UNITED AC 2009; 71:649-67. [DOI: 10.1016/j.surneu.2009.01.028] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2008] [Accepted: 01/31/2009] [Indexed: 12/16/2022]
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18
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Goto T, Tanaka Y, Kodama K, Kusano Y, Sakai K, Hongo K. Loss of visual evoked potential following temporary occlusion of the superior hypophyseal artery during aneurysm clip placement surgery. Case report. J Neurosurg 2007; 107:865-7. [PMID: 17937236 DOI: 10.3171/jns-07/10/0865] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report a case in which a 62-year-old woman with a history of subarachnoid hemorrhage due to a ruptured aneurysm was found to have a de novo paraclinoid aneurysm in the right internal carotid artery during a routine medical examination. Surgical clip placement was performed via a contralateral pterional approach under visual evoked potential (VEP) monitoring. The superior hypophyseal artery (SHA) was found to originate from the aneurysm body. The artery was temporarily occluded prior to application of the clip to the aneurysm neck. The VEP signal was lost 3 minutes after the SHA was occluded, and the potentials gradually recovered 10 minutes after the artery was released. The disappearance of VEP signal was reproducible with SHA occlusion. The clip was applied to the aneurysm body to preserve the origin of the SHA. The patient did not have any deterioration of vision after surgery. Intraoperative VEP monitoring can be used to help determine whether the SHA can be sacrificed safely.
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Affiliation(s)
- Tetsuya Goto
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
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19
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Vega-Basulto S, Gutiérrez-Muñoz F, Mosquera-Betancourt G, Rivero-Truit F, Vega-Trenado S. Aneurismas de la región de la arteria oftálmica. Neurocirugia (Astur) 2006. [DOI: 10.1016/s1130-1473(06)70331-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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20
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Thines L, Delmaire C, Le Gars D, Pruvo JP, Lejeune JP, Lehmann P, Francke JP. MRI location of the distal dural ring plane: anatomoradiological study and application to paraclinoid carotid artery aneurysms. Eur Radiol 2005; 16:479-88. [PMID: 16132925 DOI: 10.1007/s00330-005-2879-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2005] [Revised: 06/13/2005] [Accepted: 07/28/2005] [Indexed: 10/25/2022]
Abstract
The distal dural ring plane (DDRP) separates the intradural from the extradural paraclinoid internal carotid artery. The purpose of this study was to evaluate its position with MR imaging. The protocol used a T2-weighted sequence in two orthogonal planes: diaphragmatic (DIA-P) and carotid (CAR-P). The DDRP passes through four anatomoradiological reference points (RefP). We developed on a cadaveric model a correlation method supported by correlation lines and angles (CA) projecting the RefP toward the DDRP. RefP were correlated to the DDRP in 65-84% of cases in the DIA-P and 60-76% of cases in the CAR-P. CA were identified and correlated to the DDRP, respectively, in 87% and 60% of cases in the DIA-P, and 60% and 51% of cases in the CAR-P (failure often related to a lack of visibility of just one RefP). A higher tissular contrast in living subjects allowed the identification of CA in 90% and 80% of cases, respectively, in the DIA-P and the CAR-P. We propose that CA, when identified, should be considered as an approximation of the inferior radiological limit of the DDRP curve. In difficult angiographical cases, this MRI protocol could help to locate paraclinoid aneurysms on both sides of the cavernous sinus roof.
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Affiliation(s)
- Laurent Thines
- Department of Neurosurgery, University Hospital, Lille, France.
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21
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Abstract
The vascularization to the optic nerve is understood to come from the superior hypophyseal arteries and ophthalmic artery. However, anatomical studies about their detailed distribution to the optic nerve, especially its intracanalicular part, are rare. As the optic nerve is very prone to compression inside the optic canal, the vascularization here is especially at risk. This study shows that the superior hypophyseal arteries are the main source of blood supply to the intracranial and intracanalicular part of the optic nerve. The contribution of the ophthalmic artery to this part of the nerve is negligible. This artery mainly contributes to the intraorbital part of the optic nerve by means of the short and long ciliary arteries and the central retinal artery.
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Affiliation(s)
- J van Overbeeke
- Department of Neurosurgery, Neurosurgical Center Tilburg, Tilburg, The Netherlands
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22
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Abstract
The anatomic features of a transsphenoidal approach are reviewed, focusing on the microsurgical anatomy of parasellar structures. Pertinent microsurgical anatomy is described in sufficient detail for the neurosurgeon to successfully extend a standard transsphenoidal approach for treatment of lesions involving the region of the tuberculum sellae, planum sphenoidale, supradiaphragmatic intradural space, and medial cavernous sinus. The parasellar region of 50 formalin-fixed cadaveric heads was examined by using magnification 3x to 40x. The arterial and venous systems of five cadaveric specimens were injected under pressure with colored silicone rubber. The sellar region of three specimens was examined histologically. Important anatomic landmarks identified in the roof of the sphenoid sinus include a carotid and trigeminal prominence, as well as a tubercular, clival, and opticocarotid recess. The diaphragma sella is actually comprised of two layers of dura, with a venous system (circular sinus) interposed between the layers. The dura mater of the pituitary gland separates the gland from the medial compartment of the cavernous sinus. The microanatomic detail necessary to extend the transsphenoidal approach to the supradiaphragmatic intradural space and medial compartment of the cavernous sinus is described. These data are presented to facilitate the clinical application of these extended approaches.
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Affiliation(s)
- A Romano
- University Of Messina, Messina, Italy
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23
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Kim JM, Romano A, Sanan A, van Loveren HR, Keller JT. Microsurgical anatomic features and nomenclature of the paraclinoid region. Neurosurgery 2000; 46:670-80; discussion 680-2. [PMID: 10719864 DOI: 10.1097/00006123-200003000-00029] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE We describe the detailed microsurgical anatomic features of the clinoid (C5) segment of the internal carotid artery (ICA) and surrounding structures, clarify the anatomic relationships of structures in this region, and emphasize the clinical relevance of these observations. Furthermore, because the nomenclature of the paraclinoid region is confusing and lacks standardization, this report provides a glossary of terms that are commonly used to descibe the anatomic features of the paraclinoid region. METHODS The region surrounding the anterior clinoid process was observed in 70 specimens from 35 formalin-fixed cadaveric heads. Detailed microanatomic dissections were performed in 10 specimens. Histological sections of this region were obtained from the formalin-fixed cadaveric specimens. RESULTS The clinoid segment of the ICA is the portion that abuts the clinoid process. This portion of the ICA can be directly observed only after removal of the clinoid process. The dura of the cavernous sinus roof separates to enclose the clinoid process. The clinoid segment of the ICA exists only where this separation of dural layers is present. Because the clinoid process does not completely enclose the ICA in most cases, the clinoid segment is shaped more like a wedge than a cylinder. The outer layer of the dura (dura propria) is a thick membrane that fuses with the adventitia of the ICA to form a competent ring that separates the intradural ICA from the extradural ICA. The thin inner membranous layer of the dura loosely surrounds the ICA throughout the entire length of its clinoid segment. The most proximal aspect of this membrane defines the proximal dural ring. The proximal ring is incompetent and admits a variable number of veins from the cavernous plexus that accompany the ICA throughout its clinoid segment. CONCLUSION The narrow space between the inner dural layer and the clinoid ICA is continuous with the cavernous sinus via an incompetent proximal dural ring. This space between the clinoid ICA and the inner dural layer contains a variable number of veins that directly communicate with the cavernous plexus. Given the inconstancy of the venous plexus surrounding the clinoid ICA, we think that categorical labeling of the clinoid ICA as intracavernous or extracavernous cannot be justified.
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Affiliation(s)
- J M Kim
- Department of Neurosurgery, Neuroscience Institute, University of Cincinnati College of Medicine, Ohio 45267-0515, USA
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24
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25
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Lippens RJ, Rotteveel JJ, Otten BJ, Merx H. Chemotherapy with Adriamycin (doxorubicin) and CCNU (lomustine) in four children with recurrent craniopharyngioma. Eur J Paediatr Neurol 1998; 2:263-8. [PMID: 10726829 DOI: 10.1016/s1090-3798(98)80040-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The prognosis of craniopharyngioma in children after subtotal surgical removal, followed by irradiation of remaining tumour with 50 Gy, is better than usually reported. In our subjects we found a relapse rate of 5% in the last 20 years. The treatment of recurrences forms a special problem because the possibilities of adjuvant radiotherapy are restricted. We report on a chemotherapeutic treatment after multiple or very rapid recurrences of craniopharyngioma in four children. METHODS Four children experienced their first tumour recurrence at respectively 3, 8, 50 and 59 months after the initial treatment. New neurosurgical attempts to remove the recurring tumour, and in one patient a second course of radiotherapy, were performed, but there were two or more recurrences in these children, resulting in further restriction of surgical or radiotherapeutical possibilities. Chemotherapy was given, consisting of five intravenous ambulatory courses of Adriamycin (doxorubicin) (33 mg/m2/day, continuously over 3 days) together with oral CCNU (lomustine) (80 mg/m2 at day 1) at 6-weeks intervals. RESULTS After the chemotherapy there was no further tumour recurrence after 12, 10, 3 and 3 years respectively. In the third patient a cystic relapse occurred after 3 years' remission. In the fourth patient a complete regression was observed of the cystic part of the tumour. The side-effects of the chemotherapy consisted of alopecia and bone marrow depression. No signs of cardiomyopathy have been found. CONCLUSION Treatment of recurrent craniopharyngioma in children by chemotherapy with anthracyclines and nitrourea-derivates may be effective.
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Affiliation(s)
- R J Lippens
- Department of Paediatric Neurology, University Hospital, St Radboud, Nijmegen, The Netherlands
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Hitotsumatsu T, Natori Y, Matsushima T, Fukui M, Tateishi J. Micro-anatomical study of the carotid cave. Acta Neurochir (Wien) 1997; 139:869-74. [PMID: 9351992 DOI: 10.1007/bf01411405] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The surgical treatment of aneurysms located in the carotid cave is often hazardous and difficult. We studied the micro-anatomy of the carotid cave and its neighbourhood by microscopic observation and histological examination using 50 sides from 25 autopsy cases. The carotid caves were found in 34 out of the 50 sides (68%) examined and were usually located in the posteromedial aspect of the carotid dural ring. They were classified into three types according to the topographic micro-anatomy: the slit-type (17/50, 34%) which showed a small, thin recess of the dura mater with fine connective tissue loosely adhered to the carotid wall; the pocket-type (12/50, 24%) which had a definite dural pouch with the apex attached to the vessel wall; and the mesh-type (5/50, 10%) which formed a slit- or pocket-type dural cave covered with a mesh-like dural roof. The remaining 16 sides (32%) showed tight dural attachment without any caval structure around the dural ring. The posteromedial portion of the carotid dural ring had no contact with any bony structure, and this distinct anatomical feature thus appear to facilitate the formation of the carotid cave. Furthermore, the availability of this potential space and the closely situated origin of the superior hypophyseal artery as well as the haemodynamic effect of the internal carotid artery may allow the development of the carotid cave aneurysm.
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Affiliation(s)
- T Hitotsumatsu
- Department of Neurosurgery, Neurological Institute, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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Gurian JH, Viñuela F, Guglielmi G, Gobin YP, Duckwiler GR. Endovascular embolization of superior hypophyseal artery aneurysms. Neurosurgery 1996; 39:1150-4; discussion 1154-6. [PMID: 8938769 DOI: 10.1097/00006123-199612000-00016] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Internal carotid artery aneurysms arising from the superior hypophyseal artery are frequently termed paraophthalmic or paraclinoid aneurysms, but they constitute a distinct anatomic entity. They are particularly amenable to endovascular treatment. METHODS Between 1991 and 1995, we attempted treatment in 11 patients with superior hypophyseal artery aneurysms with Guglielmi detachable coil embolization and were successful in 10. Surgical exploration in seven of the patients was unsuccessful, three patients were considered to be at high risk for surgery or to have poor likelihood of surgical success by the referring neurosurgeon, and one patient refused operative clipping. Two aneurysms were giant (> 25 mm), three were large (10-25 mm), and six were small (< 10 mm). Of the six small aneurysms, two had wide necks (> 4 mm) and four had narrow necks (< or = 4 mm). RESULTS There were no technical or clinical complications related to embolization. Immediate complete aneurysm obliteration was obtained in five aneurysms, all of which were small. Four of the remaining five aneurysms had obliteration of the dome and body, leaving only a small remnant neck. The remaining semifusiform aneurysm represented our single treatment failure. Recanalization occurred in only one patient; that patient had a giant aneurysm. Nine of the 10 patients for whom embolization was successful had good or excellent clinical outcomes; there were no clinical deteriorations attributable to embolization. CONCLUSION We conclude that Guglielmi detachable coil embolization of superior hypophyseal artery aneurysms is an excellent treatment alternative, especially for smaller lesions.
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Affiliation(s)
- J H Gurian
- Department of Radiological Sciences, University of California Los Angeles Medical Center, USA
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28
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Krisht AF, Barrow DL, Barnett DW, Bonner GD, Shengalaia G. The microsurgical anatomy of the superior hypophyseal artery. Neurosurgery 1994; 35:899-903; discussion 903. [PMID: 7838339 DOI: 10.1227/00006123-199411000-00014] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Interest in the anatomy of the proximal segment of the intracranial internal carotid artery has been kindled by the recognition that there are multiple potential sites of aneurysm formation in this region. These various aneurysm locations have characteristic hemodynamic and clinical features as well as surgical considerations. Recently recognized as a distinct clinical and anatomical entity are aneurysms that are hemodynamically related to the superior hypophyseal artery. Although aneurysms arising in proximity to the superior hypophyseal artery are not rare, the anatomy of this vessel arising from the medial or posteromedial aspect of the proximal internal carotid artery is poorly understood. We performed a cadaveric microsurgical anatomical study of 20 internal carotid arteries between the ophthalmic and posterior communicating arteries to develop a better understanding of the anatomical relationships of the superior hypophyseal artery. There were an average of 1.8 superior hypophyseal arteries arising from each carotid artery with an average diameter of 0.22 mm. The origin of the superior hypophyseal arteries was within 5 mm of the ophthalmic artery origin in 85% of the specimens. There were two distinct patterns of superior hypophyseal artery anatomy. In 42%, a large, dominant superior hypophyseal artery branched like a candelabra with smaller branches to the pituitary stalk, optic nerve, and chiasm. The average diameter of the larger branches was 0.3 mm. In the absence of a large dominant branch, two or three medial vessels were found. In one specimen, an incidental aneurysm was discovered at the origin of the superior hypophyseal artery on the medial aspect of the internal carotid artery at the origin of a large candelabra-like branch.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- A F Krisht
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia
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29
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30
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Abstract
The perforating branches of the basilar artery were examined in 14 brain stems injected with india ink or methylmethacrylate. Three groups of the perforators were distinguished: the caudal, the middle, and the rostral. The caudal perforators varied in number from two to five and in diameter from 80 to 600 microns. In addition to their terminal branches, which entered the foramen cecum, the perforators occasionally branched off the pontomedullary artery, the pyramidal vessels, and the hypoglossal branches. The middle perforators arose either separately from the basilar artery or along with the basilar artery collateral branches. They ranged in number from five to nine and in diameter from 210 to 940 microns. The perforators gave rise to the pontomedullary artery (8.3%), the long pontine arteries (25.0%), and the anterolateral vessels (100%). The rostral perforators originated from the terminal part of the basilar artery (91.6%), as well as from the superior cerebellar artery (91.6%) and the posterolateral artery (16.6%). They varied in number from one to five and in diameter from 190 to 800 microns. The anastomoses among various perforating vessels were noted in 41.6 to 66.6% of the cases. The authors discussed the possible clinical significance of the anatomical data observed in this study.
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Affiliation(s)
- S V Marinković
- Institute of Anatomy, School of Medicine, University of Belgrade, Yugoslavia
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Kobayashi S, Kyoshima K, Gibo H, Hegde SA, Takemae T, Sugita K. Carotid cave aneurysms of the internal carotid artery. J Neurosurg 1989; 70:216-21. [PMID: 2913220 DOI: 10.3171/jns.1989.70.2.0216] [Citation(s) in RCA: 152] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In a series of 32 surgical cases of carotid-ophthalmic artery aneurysm, seven of the lesions were located in the "carotid cave." This special type of aneurysm is usually small and projects medially on the anteroposterior view of the angiogram. At surgery, it is located intradurally at the dural penetration of the internal carotid artery (ICA) on the ventromedial side, appears to be buried in the dural pouch (carotid cave), and is often difficult to find, dissect, and clip. The aneurysm extends into the cavernous sinus space, and the parent ICA penetrates the dural ring obliquely. An ipsilateral pterional approach was used in all 32 cases, and ring clips were used exclusively because the aneurysms were located ventromedially. Clipping was successful in five cases. All patients returned to their preoperative occupation, although vision worsened postoperatively in two cases. The technical steps required for successful obliteration of this aneurysm are summarized as follows: 1) exposure of the cervical ICA; 2) unroofing of the optic canal and removal of the anterior clinoid process; 3) exploration of the ICA around the dural ring and opening of the cavernous sinus; 4) direct retraction of the ICA and optic nerve; and 5) application of multiple ring clips to conform to the natural curvature of the carotid artery; a curved-blade ring clip is especially useful. The relevant topographic anatomy is discussed.
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Affiliation(s)
- S Kobayashi
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
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Gibo H, Watanabe N, Kobayashi S, Sugita K. Removal of an arteriovenous malformation in the optic chiasm. A case of Bonnet-Dechaume-Blanc syndrome without retinal involvement. SURGICAL NEUROLOGY 1989; 31:142-8. [PMID: 2922653 DOI: 10.1016/0090-3019(89)90329-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A rare case of an arteriovenous malformation involving the optic chiasm associated with vascular anomaly in the left maxillary region is presented. The angiogram demonstrated an arteriovenous malformation arising from the anterior circle of Willis (internal carotid, posterior communicating, and proximal anterior cerebral arteries), and located in the region of the optic chiasm and hypothalamus. The case was diagnosed as the Bonnet-Dechaume-Blanc syndrome without intraorbital and retinal arteriovenous malformations. The suprasellar arteriovenous malformation was removed, except for a small portion in the hypothalamus, with satisfactory results.
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Affiliation(s)
- H Gibo
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
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