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Luzzi S, Giotta Lucifero A, Rabski J, Kadri PAS, Al-Mefty O. The Party Wall: Redefining the Indications of Transcranial Approaches for Giant Pituitary Adenomas in Endoscopic Era. Cancers (Basel) 2023; 15:cancers15082235. [PMID: 37190164 DOI: 10.3390/cancers15082235] [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: 02/20/2023] [Revised: 03/14/2023] [Accepted: 03/29/2023] [Indexed: 05/17/2023] Open
Abstract
The evolution of endoscopic trans-sphenoidal surgery raises the question of the role of transcranial surgery for pituitary tumors, particularly with the effectiveness of adjunct irradiation. This narrative review aims to redefine the current indications for the transcranial approaches for giant pituitary adenomas in the endoscopic era. A critical appraisal of the personal series of the senior author (O.A.-M.) was performed to characterize the patient factors and the tumor's pathological anatomy features that endorse a cranial approach. Traditional indications for transcranial approaches include the absent pneumatization of the sphenoid sinus; kissing/ectatic internal carotid arteries; reduced dimensions of the sella; lateral invasion of the cavernous sinus lateral to the carotid artery; dumbbell-shaped tumors caused by severe diaphragm constriction; fibrous/calcified tumor consistency; wide supra-, para-, and retrosellar extension; arterial encasement; brain invasion; coexisting cerebral aneurysms; and separate coexisting pathologies of the sphenoid sinus, especially infections. Residual/recurrent tumors and postoperative pituitary apoplexy after trans-sphenoidal surgery require individualized considerations. Transcranial approaches still have a critical role in giant and complex pituitary adenomas with wide intracranial extension, brain parenchymal involvement, and the encasement of neurovascular structures.
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Affiliation(s)
- Sabino Luzzi
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Alice Giotta Lucifero
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Jessica Rabski
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Paulo A S Kadri
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Medical School, Federal University of Mato Grosso do Sul, Campo Grande 79070-900, Brazil
| | - Ossama Al-Mefty
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Bonneville JF, Potorac I, Tshibanda L, Martin D, Petrossians P, Beckers A. Demonstration of the inferior intercavernous sinus is closely linked to the extent of pneumatization of the sphenoid sinus: useful information for the pituitary surgeon. Pituitary 2022; 25:861-867. [PMID: 35987843 DOI: 10.1007/s11102-022-01267-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE To study the utility of T2-weighted MRI sequences in the identification of the inferior intercavernous sinus (IICS), a potential source of bleeding during transsphenoidal surgery of pituitary adenomas. METHODS Pituitary sagittal T1W and coronal T2W MRI sequences were analyzed in 237 consecutive patients, after the exclusion of postoperative MRIs and those revealing an empty sella or a pituitary macroadenoma. Sphenoid sinus pneumatization was defined as incomplete (group 1) if it did not reach the nadir of the sella turcica, as complete (group 2) if it extended beyond the nadir of the sella or asymmetric (group 3), when only one side of the sinus was completely pneumatized. RESULTS In Group 2 (70% of the patients), the IICS was rarely visualized on coronal T2W MRI (6/167 patients-3.6%), whereas in Group 1 it was identified in nearly all patients (55/57 patients - 96.5%, p < 0.001). In Group 3, the IICS was only visible above the non-pneumatized part of the sphenoid sinus. CONCLUSIONS The IICS can be identified on coronal T2W images in patients with an incompletely pneumatized sphenoid sinus, but very rarely in patients with a totally pneumatized sinus. This information can help to increase awareness among pituitary surgeons of the need to potentially manage IICS bleeding during transsphenoidal surgery in patients with an incompletely pneumatized sphenoid sinus.
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Affiliation(s)
- Jean-François Bonneville
- Department of Medical Imaging, Centre Hospitalier de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000, Liège, Belgium.
| | - Iulia Potorac
- Department of Endocrinology. Centre Hospitalier de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000, Liège, Belgium
| | - Luaba Tshibanda
- Department of Medical Imaging, Centre Hospitalier de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000, Liège, Belgium
| | - Didier Martin
- Department of Neurosurgery, Centre Hospitalier de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000, Liège, Belgium
| | - Patrick Petrossians
- Department of Endocrinology. Centre Hospitalier de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000, Liège, Belgium
| | - Albert Beckers
- Department of Endocrinology. Centre Hospitalier de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000, Liège, Belgium
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Evaluation of Inferior Intercavernous Sinus in Patients With Pituitary Microadenoma by Contrast-Enhanced SPACE Imaging. J Comput Assist Tomogr 2022; 46:961-967. [DOI: 10.1097/rct.0000000000001371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Zhang Z, Fang Q, Zhang Y, Zhu Y, Zhang W, Zhu Y, Deng X. Magnetic resonance analysis of deep cerebral venous vasospasm after subarachnoid hemorrhage in rabbits. Front Cardiovasc Med 2022; 9:1013610. [PMID: 36211577 PMCID: PMC9532692 DOI: 10.3389/fcvm.2022.1013610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 08/29/2022] [Indexed: 11/30/2022] Open
Abstract
Objective Arterial spasm is proved to be an inducer of cerebral ischemia and cerebral infarction, while when a venous spasm occurs, cerebral edema is seen to be caused by a disturbance in cerebral blood flow. However, it is unclear and unproven whether venous spasm occurs after subarachnoid hemorrhage (SAH). To provide the theoretical basis for treating cerebral vasospasm after SAH, magnetic resonance imaging (MRI) was employed to observe the changes in the diameter of deep cerebral veins in rabbits after SAH. Methods Fourteen New Zealand rabbits were randomly divided into the SAH group (n = 10) and the normal saline group (NS group, n = 4). Specifically, the SAH models were established by the ultrasound-guided double injections of blood into cisterna magna. Moreover, the MRI was performed to observe the changes in the diameter of deep cerebral veins (internal cerebral vein, basilar vein, and great cerebral vein) and basilar artery before modeling (0 d) and 1, 3, 5, 7, 9, and 11 d after modeling. Results In the SAH group, the diameter of the basilar artery showed no evident change on the 1st d. However, it became narrower obviously on the 3rd d and 5th d, and the stenosis degree was more than 30%. The diameter gradually relieved from 7th to 9th d, and finally returned to normal on the 11th d. Moreover, the diameter of the internal cerebral vein significantly narrowed on the 1st d, the stenosis degree of which was 19%; the stenosis then relieved slightly on the 3rd d (13%), reached the peak (34%) on the 5th d, and gradually relieved from 7th d to 11th d. Moreover, the stenosis degree of the basilar vein was 18% on the 1st d, 24% on the 3rd d, and reached the peak (34%) on the 5th d. Conclusion After SAH in rabbits, the cerebral vasospasm was seen to occur in the basilar artery, and likewise, spasmodic changes took place in the deep cerebral vein. Furthermore, the time regularity of spasmodic changes between the cerebral vein and basilar artery was of significant difference, indicating that the venous vasospasm resulted in active contraction.
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Affiliation(s)
- Zixuan Zhang
- Department of Clinical Medicine, West Anhui Health Vocational College, Lu'an, China
- Department of Anatomy, Anhui Medical University, Hefei, China
| | - Qiong Fang
- Department of Basic Medicine, Anhui Medical College, Hefei, China
| | - Yu Zhang
- Department of Radiology, The 901st Hospital of the Joint Logistics Support Force of PLA, Hefei, China
| | - Youzhi Zhu
- Department of Radiology, The 901st Hospital of the Joint Logistics Support Force of PLA, Hefei, China
| | - Wei Zhang
- Department of Anatomy, Anhui Medical University, Hefei, China
| | - Youyou Zhu
- Department of Anatomy, Anhui Medical University, Hefei, China
| | - Xuefei Deng
- Department of Anatomy, Anhui Medical University, Hefei, China
- *Correspondence: Xuefei Deng
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Radiomics Model Based on Enhanced Gradient Level Set Segmentation Algorithm to Predict the Prognosis of Endoscopic Treatment of Sinusitis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:9511631. [PMID: 35785138 PMCID: PMC9242818 DOI: 10.1155/2022/9511631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/01/2022] [Accepted: 06/09/2022] [Indexed: 11/18/2022]
Abstract
Methods Computed tomography (CT) images of sinusitis in 91 patients were collected. By introducing boundary gradient information into the edge detection function, the sensitivity of the level set model to the boundary of different intensities of lesions was adjusted to obtain accurate segmentation results. After that, the segmented CT image was imported into Mazda texture analysis software for feature extraction. Three dimensionality reduction methods were used to screen the best texture features. Four analysis methods in the B11 module were used to calculate the misclassified rate (MCR). Results The segmentation algorithm based on an enhanced gradient level set has good segmentation results for sinusitis lesions. The radiomics results show that the raw data analysis method under the Fisher dimensionality reduction method has a low MCR (25.27%). Conclusion The enhanced gradient level set segmentation algorithm can segment sinusitis lesions accurately. The radiomics model effectively predicts the prognosis of endoscopic treatment of sinusitis.
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Kosty J, Peterson R, Miriyala S, Banks T, Kandregula S, Dossani RH, Guthikonda B. An anatomic assessment of the intercavernous sinuses and review of the literature. J Neurol Surg B Skull Base 2022; 84:266-271. [PMID: 37187479 PMCID: PMC10171929 DOI: 10.1055/a-1819-0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/03/2022] [Indexed: 10/18/2022] Open
Abstract
Background
As expanded endoscopic endonasal approaches are gaining popularity, a thorough understanding of the anatomy of the intercavernous sinuses is pertinent to avoid bleeding complications. There have been few studies reporting the presence and dimensions of the anterior (AIS), posterior (PIS), and inferior (IIS) intercavernous sinuses. We performed a cadaveric study to better understand these structures.
Methods
Colored latex was injected into the arterial and venous trees of seventeen cadaveric heads. Dissections assessed the presence and dimensions of the anterior, posterior, and inferior intercavernous sinuses. In an additional 3 specimens, the sellar contents were subjected to histologic analysis.
Results
In thirteen specimens (59%), all three sinuses were identified. In 5 specimens (33%), only the anterior and posterior intercavernous sinuses could be identified, and in one specimen, only an anterior and inferior sinus were identified. An AIS was identified in all 20 (100%) specimens, PIS in 17 (85%), and an IIS in 13 (66)%. In two specimens (10%), the AIS covered the entire face of the sella. Dimensions of the AIS averaged 1.7 x 11.7 x 2.8 mm, PIS averaged 1.5 x 10.8 x 1.7 mm, and IIS averaged 8.7 x 11.8 x 1.0 mm when present.
Conclusion
All examined specimens demonstrated the presence of an anterior intercavernous sinus, and most had a posterior intercavernous sinus. The presence of an inferior intercavernous sinus was more variable. Preoperative awareness of these sinuses is helpful in planning transphenoidal surgery in order to minimize the risk of bleeding.
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Affiliation(s)
- Jennifer Kosty
- Neurosurgery, LSU Health Shreveport, Shreveport, United States
| | | | | | - Timothy Banks
- Neurosurgery, LSU Health Shreveport, Shreveport, United States
| | | | - Rimal H Dossani
- Neurosurgery, LSU Health Shreveport, Shreveport, United States
- Neurosurgery, University at Buffalo, Buffalo, United States
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Arachnoid and dural reflections. HANDBOOK OF CLINICAL NEUROLOGY 2021; 169:17-54. [PMID: 32553288 DOI: 10.1016/b978-0-12-804280-9.00002-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The dura mater is the major gateway for accessing most extra-axial lesions and all intra-axial lesions of the central nervous system. It provides a protective barrier against external trauma, infections, and the spread of malignant cells. Knowledge of the anatomical details of dural reflections around various corners of the skull bases provides the neurosurgeon with confidence during transdural approaches. Such knowledge is indispensable for protection of neurovascular structures in the vicinity of these dural reflections. The same concept is applicable to arachnoid folds and reflections during intradural excursions to expose intra- and extra-axial lesions of the brain. Without a detailed understanding of arachnoid membranes and cisterns, the neurosurgeon cannot confidently navigate the deep corridors of the skull base while safely protecting neurovascular structures. This chapter covers the surgical anatomy of dural and arachnoid reflections applicable to microneurosurgical approaches to various regions of the skull base.
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Chenin L, Toussaint P, Lefranc M, Havet E, Peltier J. Microsurgical anatomy of the inferior intercavernous sinus. Surg Radiol Anat 2020; 43:211-218. [PMID: 32975638 DOI: 10.1007/s00276-020-02581-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/15/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Intercavernous sinuses (ICSs) are physiological communications between the cavernous sinuses. The ICSs run between the endosteal and meningeal layers of the dura mater of the sella turcica. Whereas the anterior and posterior ICSs have been frequently described, the inferior ICS (iICS) has been less well studied in the literature; however, poor awareness of the ICS's anatomy can lead to serious problems during transsphenoidal, transsellar surgery. The objective of the present anatomical study was to describe the iICS in detail. METHODS The study was carried out over a 6-month period in a university hospital's anatomy laboratory, using brains extracted from human cadavers. The brains were injected with colored neoprene latex and dissected to study the iICS (presence or absence, shape, diameter, length, distance between inferior and anterior ICSs, distance between inferior and posterior ICSs, relationships, and boundaries). RESULTS Seventeen cadaveric specimens were studied, and an iICS was found in all cases (100%). The shape was variously plexiform (47.1%), filiform (35.3%), or punctiform (17.6%). The mean ± standard deviation diameter and length of the iICS were 3.75 ± 2.90 mm and 11.92 ± 2.96 mm, respectively. The mean iICS-anterior ICS and iICS-posterior ICS distances were 5.36 ± 1.99 mm and 7.03 ± 2.28 mm, respectively. CONCLUSION The iICS has been poorly described in the literature. However, damage to the iICS during transsphenoidal, transsellar surgery could lead to serious vascular complications. A precise radiological assessment appears to be essential for a safe surgical approach.
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Affiliation(s)
- Louis Chenin
- Department of Anatomy and Organogenesis, Faculty of Medicine, Jules Verne University of Picardie, 80000, Amiens, France. .,Department of Neurosurgery, Amiens University Hospital, 80000, Amiens, France.
| | - Patrick Toussaint
- Department of Neurosurgery, Amiens University Hospital, 80000, Amiens, France
| | - Michel Lefranc
- Department of Neurosurgery, Amiens University Hospital, 80000, Amiens, France
| | - Eric Havet
- Department of Anatomy and Organogenesis, Faculty of Medicine, Jules Verne University of Picardie, 80000, Amiens, France
| | - Johann Peltier
- Department of Anatomy and Organogenesis, Faculty of Medicine, Jules Verne University of Picardie, 80000, Amiens, France.,Department of Neurosurgery, Amiens University Hospital, 80000, Amiens, France
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Narayan RK, Asghar A, Ghosh SK. Ossification around intercavernous sinus: An osteological finding that can complicate trans - sphenoidal surgery. Morphologie 2020; 104:280-286. [PMID: 32646846 DOI: 10.1016/j.morpho.2020.06.005] [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: 04/06/2020] [Revised: 06/05/2020] [Accepted: 06/12/2020] [Indexed: 11/16/2022]
Abstract
The aim of the study was to document an anatomical variation around the sella turcica which was unique and lacked any reference in the literature. A low lying osseous bar connecting the right middle clinoid process to the midpoint of the right lateral border of the dorsum sella was observed in a human skull specimen. The osseous bar was forming a foramen close to the floor of the sella, and the structure in association with this part of sella is the inferior intercavernous sinus. Measurements of the sella turcica bridge (STB), carotico-clinoid foramen (CCF), interclinoid foramen (ICF) on both sides and that of the ossified bar and foramen formed by itself were taken with the help of ImageJ software. The values observed for the measurements of different parameters of STB and its components, for CCF and ICF were bilaterally different. While the values for the osseous bar and foramen formed by it cannot be compared because of its unilateral occurrence. The presence of foramen around the inferior intercavernous sinus may lead to difficulty in performing procedures like transsphenoidal surgery (TSS) or extended TSS (eTSS) while extracting intradural lesions, thus increasing the chances of haemorrhage.
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Affiliation(s)
- R K Narayan
- Department of Anatomy, All India Institute of Medical Sciences, Patna, 801507 Bihar, India.
| | - A Asghar
- Department of Anatomy, All India Institute of Medical Sciences, Patna, 801507 Bihar, India
| | - S K Ghosh
- Department of Anatomy, All India Institute of Medical Sciences, Patna, 801507 Bihar, India
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Wahl L, Lockwood JD, Keet K, Henry BM, Gielecki J, Iwanaga J, Bui CJ, Dumont AS, Tubbs RS. The inferior intercavernous sinus: An anatomical study with application to trans-sphenoidal approaches to the pituitary gland. Clin Neurol Neurosurg 2020; 196:106000. [PMID: 32574965 DOI: 10.1016/j.clineuro.2020.106000] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 06/02/2020] [Accepted: 06/05/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The inferior intercavernous sinus is located below the pituitary gland in the sella turcica. Its presence has been controversial among anatomists because it is not always found on radiological imaging or during cadaveric dissections; however, it is becoming a better-known structure in the neurosurgical and radiological fields, specifically with respect to transsphenoidal surgery. Therefore, the present study was performed to better elucidate this structure at the skull base. PATIENTS AND METHODS Fifty adult, latex injected cadavers underwent dissection. The presence or absence of the inferior cavernous sinus was evaluated and when present, measurements of its width and length were made. Its connections with other intradural venous sinuses were also documented. RESULTS An inferior intercavernous sinus was identified in 26 % of specimens. In all specimens, it communicated with the left and right cavernous sinus. The average width and length were 3 mm and 9.5 mm, respectively. In the sagittal plane, the inferior intercavernous sinus was positioned anteriorly in 31 %, at the nadir of the sella turcica in 38 %, and slightly posterior to the nadir of the sella turcica in 31 %. In two specimens (15.4 %), the sinus was plexiform in its shape. In one specimen a diploic vein connected the basilar venous plexus to the inferior intercavernous sinus on its deep surface. CONCLUSION An improved understanding of the variable anatomy of the inferior intercavernous sinus is important in pathological, surgical, and radiological cases.
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Affiliation(s)
- Lauren Wahl
- Department of Cell and Developmental Biology, University of Colorado, Boulder CO, USA
| | - Joseph D Lockwood
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
| | - Kerri Keet
- Division of Clinical Anatomy, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Brandon Michael Henry
- Cardiac Intensive Care Unit, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - Jerzy Gielecki
- Department of Radiology, Collegium Medicum, School of Medicine, University of Warmia and Mazury, Olsztyn, Poland; Department of Anatomy, University of Warmia and Mazury, Olsztyn, Poland
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA.
| | - C J Bui
- Department of Neurosurgery, Ochsner Medical Center, New Orleans, LA, USA
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA; Department of Anatomical Sciences, St. George's University, St. George's, West Indies, Grenada; Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA
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Skull Base Venous Anatomy Associated with Endoscopic Skull Base Neurosurgery: A Literature Review. World Neurosurg 2018; 120:405-414. [DOI: 10.1016/j.wneu.2018.09.067] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/07/2018] [Accepted: 09/11/2018] [Indexed: 11/21/2022]
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