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Ruiz-Valdepeñas EC, Ruiz EB, Cancela AA, Berrocal VR. How I do it: Endoscopic endonasal resection of the medial wall of the cavernous sinus. Acta Neurochir (Wien) 2024; 166:298. [PMID: 39009772 DOI: 10.1007/s00701-024-06177-w] [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: 01/08/2024] [Accepted: 06/26/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Resection of the medial wall of the cavernous sinus (MWCSR) is a growing surgical maneuver for the radical removal of pituitary adenomas. METHOD We present a simple modification of the technique following the two dural layers of the floor of the sella turcica, allowing for early identification of the medial wall and simplifying dissection. We support this technique with an anatomical analysis on cadaveric specimens and clarifying dissection images. CONCLUSION Recognition and dissection of the dural unfolding of the floor of the sella turcica are "key points" that lower the risk and facilitate the MWCSR.
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Serioli S, Plou P, Donato G, Graepel S, Ajler P, De Bonis A, Pinheiro-Neto CD, Leonel LCPC, Peris-Celda M. The Coexistence of Carotico-Clinoid Foramen and Interclinoidal Osseous Bridge: An Anatomo-Radiological Study With Surgical Implications. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01239. [PMID: 38968000 DOI: 10.1227/ons.0000000000001258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/03/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The coexistence of complete carotico-clinoid bridge (CCB), an ossification between the anterior (ACP) and the middle clinoid (MCP), and an interclinoidal osseous bridge (ICB), between the ACP and the posterior clinoid (PCP), represents an uncommonly reported anatomic variant. If not adequately recognized, osseous bridges may complicate open or endoscopic surgery, along with the pneumatization of the ACP, especially when performing anterior or middle clinoidectomies. METHODS According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews guidelines, a systematic scoping review was conducted up to June 5, 2023. PubMed, Scopus, Web of Science databases, and additional citations were searched. Two hundred high-resolution noncontrast computed tomography (CT) scans (400 sides) and 41 dry skulls (82 sides) were analyzed to identify the different morphology of sellar bridges, focusing on the coexistence of complete CCF and ICB. Two embalmed latex-injected heads with coexisting CCF and ICB were dissected step-by-step to show the anatomic relationship with the surrounding structures from an endoscopic and microscopic perspective. RESULTS A total of 19 articles were included. The review identified a complete CCF and ICB rate ranging from 4.92% to 6.3%. The analysis of 200 CT scans revealed a rate of coexistence in 4% of the cases, all encountered in White women. Two different types of interclinoid bridges were identified based on the degree of bone mineralization. Both endoscopic and macroscopic step-by-step dissections highlighted variability in morphology and consistency of the sellar bridges and the close relationship with the cavernous sinus neurovascular structures. CONCLUSION The coexistence of CCF and ICB is an anatomic variation found in 4% of cases. Preoperative knowledge of the degree of mineralization and its relationship with surrounding structures is essential to performing safe surgery and minimizing cranial nerve and vascular injuries. Preoperative high-resolution CT scans can adequately identify these anatomic variations.
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Affiliation(s)
- Simona Serioli
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Pedro Plou
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Neurosurgery, Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Glaudir Donato
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Medical Sciences Center, Federal University of Paraiba, João Pessoa, Brazil
| | - Stephen Graepel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Pablo Ajler
- Neurosurgery, Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Alessandro De Bonis
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Carlos D Pinheiro-Neto
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Luciano C P C Leonel
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Maria Peris-Celda
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, 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. [PMID: 38468565 DOI: 10.1002/ca.24152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 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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Nizzola M, Leonel LCPC, Peris-Celda M. Neurosurgery for the rhinologist. Curr Opin Otolaryngol Head Neck Surg 2024; 32:40-49. [PMID: 38193519 DOI: 10.1097/moo.0000000000000950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide a comprehensive anatomical appraisal of the neurosurgical anatomy exposed through the endonasal and paranasal sinuses routes, focusing on the most common expanded endonasal approaches (EEAs) as well as recent advances in this surgical field. RECENT FINDINGS The EEAs are redefining the management of skull base pathology. Neurovascular structures previously considered a limitation, can be now approached through these surgical corridors. Advances in this field include the development of new surgical techniques and routes that allow better visualization and access to pathologies located in the ventral skull base. Understanding the surgical anatomy related to EEAs is essential not only for neurosurgeons but also for rhinologists. SUMMARY Knowledge of the surgical anatomy of the most common EEAs that utilize paranasal sinuses as a surgical corridor enables more effective management of complex skull base pathologies. Comprehensive anatomical knowledge of these corridors and the surrounding neurovascular structures is crucial to maximize benefits of EEAs and improve outcomes.
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Affiliation(s)
- Mariagrazia Nizzola
- Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurosurgery and Gamma Knife radiosurgery, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Luciano C P C Leonel
- Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Maria Peris-Celda
- Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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