The parasellar region of human infants: cavernous sinus topography and surgical approaches

Weninger, Wolfgang J.; Mülle, Gerd B.

doi:10.3171/foc.1999.6.1.2

Cited by 12 publications

(17 citation statements)

References 39 publications

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“…36 In fetuses and neonates, the pICA is generally less bent than in adults. 33,34,37 In this study, a statistically significant correlation between the shape of the pICA and the degree of intimal hyperplasia in the C4 and the C5 segments was shown. Strongly curving pICAs exhibited a high incidence of C4 and C5 cushions, whereas straight pICAs exhibited a low incidence of intimal cushions.…”

Section: Discussionsupporting

confidence: 57%

“…This indicates that the shape of the pICA is strongly transformed during early childhood. 37 This period of life also coincides with the occurrence of sudden infant death syndrome (SIDS).…”

mentioning

confidence: 98%

“…This indicates that the shape of the pICA is strongly transformed during early childhood. 37 This period of life also coincides with the occurrence of sudden infant death syndrome (SIDS).One of the established factors in the multifactorial genesis of SIDS is lack of oxygen in the brain, 38 which can also be caused by lumen occlusion of large arteries and the consequent deficiency of blood supply. 39 We hypothesized that unusually strong intimal hyperplasia in the pICA could represent another possible cause for a reduced blood supply to the brain of neonates and infants.…”

mentioning

confidence: 99%

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Intimal Hyperplasia of the Infant Parasellar Carotid Artery

Weninger

Müller

Reiter

et al. 1999

Circulation Research

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Abstract-Intimal cushions that project into the lumen of arteries are precursors of atherosclerotic plaque formation. The "carotid siphon," although frequently affected by atherosclerosis, was never analyzed for the occurrence of neonatal intimal hyperplasia. This study provides a topographic and morphometric analysis of intimal cushions in the parasellar internal carotid artery (pICA) of the human infant. A total of 35 specimens were studied in detail, using both standard histological techniques and a new method of computer-aided 3D reconstruction. Intimal hyperplasia occurred at 3 characteristic locations of the pICA: (1) the convex side of the posterior knee (C5 cushion), (2) the bottom of the horizontal segment (C4 cushion), and (3) the concave side of the anterior knee (C3 cushion). The extension of the cushions and the degrees to which they occluded the vessel lumens were measured. The complex shape of the pICA required 3D computer models for exact topographical descriptions and precise measurements. Our results suggest that the occurrence and degree of intimal hyperplasia are related to shape changes of the pICA during postnatal development. We predict that individuals who retain the relatively straight course of the fetal pICA throughout their lives are less prone to develop atherosclerotic lesions at this portion of the carotid artery. Key Words: intimal cushion Ⅲ hemodynamics Ⅲ 3D reconstruction Ⅲ internal carotid artery Ⅲ child I n the carotid artery system, the parasellar internal carotid artery (pICA) has a high propensity toward atherosclerosis, and lesions at this location frequently cause stroke. 1-7 Sites of intimal hyperplasia, which appear as intimal cushions that project into the lumen of arteries, represent precursors of atherosclerosis. 8,9 Such intimal cushions occur after vascular injury 10 -12 and vascular surgery, 13-17 but they are also physiologically present near the branchings and divisions of intracranial arteries in neonates 18 -21 and infants. [22][23][24] The extracranial carotid system and its intracranial branches have been studied extensively in regard to intimal hyperplasia and atherosclerosis. [25][26][27][28] In contrast, information about the occurrence, position, and size of intimal hyperplasia in the pICA is scant, and information about atherosclerotic plaques is contradictory. 29 -35 This lack of information is caused by the hidden position of the pICA, which prevents the use of modern in vivo techniques such as ultrasound. In addition, the strongly curved course of the blood vessel impedes exact positional and morphometric analyses based on individual histological sections.In 84% of adults, the pICA has the characteristic doublebent shape that gave rise to the term "carotid siphon," 36 but in all neonates, the pICA takes a much straighter course. This indicates that the shape of the pICA is strongly transformed during early childhood. 37 This period of life also coincides with the occurrence of sudden infant death syndrome (SIDS).One of the established factors in the...

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Section: Discussionsupporting

confidence: 57%

“…This indicates that the shape of the pICA is strongly transformed during early childhood. 37 This period of life also coincides with the occurrence of sudden infant death syndrome (SIDS).…”

mentioning

confidence: 98%

mentioning

confidence: 99%

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Intimal Hyperplasia of the Infant Parasellar Carotid Artery

Weninger

Müller

Reiter

et al. 1999

Circulation Research

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“…So, someone insist that the term of petroclival venous confluens is appropriate instead of Dorello's canal 1) . The abducens nerve is enveloped by cerebral dura of petroclival region, separated from the venous blood and the subarachnoid space also extends toward the cavernous sinus along the nerve 1,2,[9][10][11][12]14,17) . We also found the both branches to be enveloped by cerebral dural layer and separated from venous blood.…”

Section: Discussionmentioning

confidence: 99%

A Case of Aberrant Abducens Nerve in a Cadaver and Review of Its Clinical Significance

Choi

Han

Yee

et al. 2010

J Korean Neurosurg Soc

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J Korean Neurosurg Soc 47 : [377][378][379][380] 2010 The abducens nerve usually travels from the brainstem to the lateral rectus muscle as a single trunk. However, it has been reported that this nerve could split into branches occasionally. We attempted to show the aberrant course of abducens nerve in a specimen with unilateral duplicated abducens nerve and review relevant literatures. The micro-dissections were performed in a head specimen injected with colored latex under the microscope. The abducens nerve was duplicated unilaterally. This nerve emerged from the pontomedullary sulcus as a single trunk and splitted into two branches in the prepontine cistern. These two separate branches were piercing the cerebral dura of the petroclival region respectively. The slender lower branch passed between the petroclinoid and petrosphenoid ligaments and the thick lower one passed under the petrosphenoid ligament. These two branches united just lateral to the ascending segment of internal carotid artery in the cavernous sinus. The fact that there are several types of aberrant abducens nerve is helpful to perform numerous neurosurgical procedures in the petroclival region and cavernous sinus without inadvertent neurovascular injuries.

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“…The oculomotor, the trochlear, and the first division of the trigeminal nerve are located in a connective tissue layer beneath the dura mater of the middle cranial fossa, which forms the lateral wall of the parasellar space. To avoid confusion and emphasize that the entire space belongs to the so-called extradural neural axis compartment it was proposed to rename the cavernous sinus the lateral sellar compartment (Parkinson, 1995(Parkinson, , 2000; however, first in infants (Weninger et al, 1997;Weninger and Mü ller, 1999) and later in adults (Weninger and Pramhas, 2000) it became evident that this space represents not a single homogenous compartment, but three distinct spaces that are clearly separated by connective tissue. Thus, it is suggested to apply the term "lateral sellar compartment" only to the larger and most posterior space and to term the entire region, formerly known as the cavernous sinus, as the parasellar region (PSR).…”

Section: Introductionmentioning

confidence: 99%

In vivo 3D analysis of the adipose tissue in the orbital apex and the compartments of the parasellar region

Weninger

Prokop

2004

Clinical Anatomy

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As tissue dissections carried out on formaldehyde-fixed anatomical specimens demonstrate, the parasellar region (PSR), traditionally referred to as the cavernous sinus, is composed of three distinct compartments: orbital, pterygopalatine, and lateral sellar. The aim of our study was to identify and measure these compartments in the living and to describe the topography of their adipose body tissues. For this purpose data sets of 35 patients, who had undergone thin-section multislice computed tomography (CT), were examined using 3D-reconstruction software. The pterygopalatine and orbital compartments of the PSR could be identified in the images by their adipose bodies. We provide more exacting measurements of their size than have been presented in earlier studies. Furthermore, we include data about the uni- and bilateral presence of the single compartments and analyze the topography of the adipose tissue bodies in the orbital apex region. Our quantitative data and topographical descriptions confirm the compartmentalization concept of the PSR, allow for correct interpretation of CT scans of the orbital apex and anterior PSR, and provide baseline information for individual planning of surgical and radiological interventions.

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The parasellar region of human infants: cavernous sinus topography and surgical approaches

Cited by 12 publications

References 39 publications

Intimal Hyperplasia of the Infant Parasellar Carotid Artery

Intimal Hyperplasia of the Infant Parasellar Carotid Artery

A Case of Aberrant Abducens Nerve in a Cadaver and Review of Its Clinical Significance

In vivo 3D analysis of the adipose tissue in the orbital apex and the compartments of the parasellar region

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