The inferior intercavernous sinus: An anatomical study with application to trans-sphenoidal approaches to the pituitary gland

Wahl, Lauren; Lockwood, Joseph; Keet, Kerri; Henry, Brandon Michael; Gielecki, Jerzy; Iwanaga, Joe; Bui, Cuong J.; Dumont, Aaron S.; Tubbs, R. Shane

doi:10.1016/j.clineuro.2020.106000

Cited by 6 publications

(5 citation statements)

References 28 publications

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“…The detection rate of iICS was both more than 94% in 2 studies on serial microscopic sections 3,18 . Other researchers, however, who performed macroscopic evaluation on cadaveric specimens, found the presence of iICS varied from 17% to 100% 1,2,16,17,19,20 . With regard to the shape of iICS, plexiform was the most frequent in these researches.…”

Section: Discussionmentioning

confidence: 76%

“…3,18 Other researchers, however, who performed macroscopic evaluation on cadaveric specimens, found the presence of iICS varied from 17% to 100%. 1,2,16,17,19,20 With regard to the shape of iICS, plexiform was the most frequent in these researches. Deng and coworkers 17 demonstrated what was mostly presented as a crescent or oval shape in the midsagittal section of the cadavers, which are similar to our results.…”

Section: Discussionmentioning

confidence: 95%

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Evaluation of Inferior Intercavernous Sinus in Patients With Pituitary Microadenoma by Contrast-Enhanced SPACE Imaging

Zhao

Rui

et al. 2022

J Comput Assist Tomogr

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ObjectiveInferior intercavernous sinus (iICS) is a venous channel below the pituitary gland. Inferior intercavernous sinus injury is predisposed to cause venous bleeding during dura incision in transsphenoidal surgery for pituitary adenomas. Therefore, this study aimed to perform a radiological assessment of iICS before transsphenoidal surgery for pituitary microadenoma.MethodsA retrospective evaluation was performed on 156 patients who underwent magnetic resonance imaging examinations in our hospital before endoscopic transsphenoidal surgery for pituitary microadenoma. Both sagittal reformatted and coronal contrast-enhanced (CE) sampling perfection with application optimized contrast using different flip angle evolutions (SPACE) images were interpreted for the presence, shape, and size of the iICS.ResultsIn CE SPACE, the iICS was identified in 72 patients (46.15%) with pituitary microadenoma. The iICS was appeared as a filiform-shaped hyperintense structure below the pituitary gland on coronal CE SPACE planes and a crescent-shaped hyperintense structure on sagittal CE SPACE planes. The mean ± SD width, depth, and height of iICS were 11.15 ± 3.47 mm, 5.29 ± 1.24 mm, and 1.41 ± 0.19 mm, respectively.ConclusionsContrast-enhanced SPACE may serve as a promising technique in evaluating iICS and individualized preoperative planning before transsphenoidal surgery for pituitary microadenoma.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 95%

Evaluation of Inferior Intercavernous Sinus in Patients With Pituitary Microadenoma by Contrast-Enhanced SPACE Imaging

Zhao

Rui

et al. 2022

J Comput Assist Tomogr

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“…The location of the basilar venous plexus must also be considered during skull base surgery, especially during endoscopic transsphenoidal and transclival approaches, which allow surgeons access to the ventral brainstem [ 21 ]. In a recent cadaveric study of the inferior intercavernous sinus and its applications to trans-sphenoidal pituitary surgery, Wahl et al [ 22 ] described a connection between the basilar venous plexus and the inferior intercavernous sinus. This connection was found on the inferior surface via a diploic vein in one specimen among 50, highlighting the variability in venous drainage of this area and the importance of considering it prior to surgery.…”

Section: Discussionmentioning

confidence: 99%

Trabeculae in the basilar venous plexus: anatomical and histological study with application to intravascular procedures

Grayson,

Couldwell,

Chaiyamoon

et al. 2023

Anat Cell Biol

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Few studies have examined the basilar venous plexus (BVP) and to our knowledge, no previous study has described its histology. The present anatomical study was performed to better elucidate these structures. In ten cadavers, the BVP was dissected. The anatomical and histological evaluation of the intraluminal trabeculae within this sinus were evaluated. Once all gross measurements were made, the clivus and overlying BVP were harvested and submitted for histological analysis. A BVP was identified in all specimens and in each of these, intraluminal trabeculae were identified. The mean number of trabeculae per plexus was five. These were most concentrated in the upper half of the clivus and were more often centrally located. These septations traveled in a posterior to anterior direction and usually, from inferiorly to superiorly however some were noted to travel horizontally. In a few specimens the trabeculae had wider bases, especially on the posterior attachment to the meningeal layer of dura mater. More commonly, the trabeculae ended in a denticulate form at their two terminal ends. The trabeculae were on average were 0.85 mm in length. The mean width of the trabeculae was 0.35 mm. These septations were consistent with the cords of Willis as are found in the lumen of some of the other intradural venous sinuses. An understanding of the internal anatomy of the BVP can aid in our understanding of venous pathology. Furthermore, this knowledge will benefit patients undergoing interventional treatments that involve the BVP.

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“…The anterior intercavernous sinus has been observed most reliably in the literature, while the posterior and inferior intercavernous sinuses are found less frequently. [1][2][3][4][5] Characterizing the size and presence of these sinuses has become more important as expanded endoscopic endonasal approaches gain popularity. Large intercavernous sinuses can lead to bleeding that obscures the surgeon's view and have been implicated in venous air embolisms during transphenoidal surgery.…”

Section: Introductionmentioning

confidence: 99%

“…The AIS has been observed most reliably in the literature, while the PIS and IIS are found less frequently. 1 2 3 4 5…”

Section: Introductionmentioning

confidence: 99%

An Anatomic Assessment of the Intercavernous Sinuses and Review of the Literature

Kosty

Peterson

Miriyala

et al. 2022

J Neurol Surg B Skull Base

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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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The inferior intercavernous sinus: An anatomical study with application to trans-sphenoidal approaches to the pituitary gland

Cited by 6 publications

References 28 publications

Evaluation of Inferior Intercavernous Sinus in Patients With Pituitary Microadenoma by Contrast-Enhanced SPACE Imaging

Evaluation of Inferior Intercavernous Sinus in Patients With Pituitary Microadenoma by Contrast-Enhanced SPACE Imaging

Trabeculae in the basilar venous plexus: anatomical and histological study with application to intravascular procedures

An Anatomic Assessment of the Intercavernous Sinuses and Review of the Literature

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