Microsurgical anatomy of the pituitary gland (hypophysis cerebri) and the sellar region. Part IV: The optic nerves and optic chiasma

1988 ◽  
Vol 1 (2) ◽  
pp. 131-145 ◽  
Author(s):  
Georges Elie Ouaknine
Keyword(s):  
Pituitary Gland ◽  
Microsurgical Anatomy ◽  
Sellar Region ◽  
Optic Chiasma ◽  
Optic Nerves

Juvenile Xanthogranuloma of the Sellar Region with a 5-Year Medical History: Case Report and Literature Review

2021 ◽  
pp. 1-8
Author(s):  
Dekui Cheng ◽  
Fengyu Yang ◽  
Ziji Li ◽  
Fan Qv ◽  
Wei Liu
Keyword(s):  
Medical History ◽  
Pediatric Population ◽  
Benign Lesion ◽  
Giant Cells ◽  
Juvenile Xanthogranuloma ◽  
Epithelial Tissue ◽  
Sellar Region ◽  
Optic Chiasma ◽  
Suprasellar Region ◽  
Field Disturbance

<b><i>Introduction:</i></b> Xanthogranuloma of the sellar region is a rare benign lesion, and there are few cases reported in children. Its histogenesis is controversial, and it is difficult to strictly differentiate it from craniopharyngioma (CP), Rathke’s cleft cyst, or pituitary adenoma. <b><i>Case Presentation:</i></b> A 16-year-old boy presented with a rare xanthogranuloma of the sellar region after complaining of retardation of growth 5 years previously. The ophthalmologic evaluation revealed no visual field disturbance. Endocrinological examination revealed hypopituitarism. Magnetic resonance imaging showed an intrasellar mass extending into the suprasellar region and compressing the optic chiasma, which appeared mixed signals on T1-weighted images. Endonasal transsphenoidal resection of the tumor was performed. Histological analysis of the tumor sections demonstrated granulomatous tissue with cholesterol clefts, hemosiderin deposits, fibrous tissues, multinucleated giant cells, and lymphocyte. Thus, the tumor was pathologically diagnosed as xanthogranuloma of the sellar region, which is different from adamantinomatous CP. There was no epithelial tissue in any part of the tumor including tumor capsule but have focal necrosis and calcification. His endocrinological dysfunction did not recover, so a hormonal replacement was continuously required. <b><i>Conclusion:</i></b> Xanthogranuloma of the sellar region is a rare entity but must be considered in the differential diagnosis of lesions of the sellar region, even in pediatric population. We should think about this disease when dealing with children with stunted growth accompanied by a long medical history. Our case demonstrates the natural progression of the disease, suggesting that xanthogranuloma of the sellar region without epithelial components may be an independent disease.

Microsurgical anatomy of membranous layers of the pituitary gland and the expression of extracellular matrix collagenous proteins

2011 ◽  
Vol 153 (12) ◽  
pp. 2435-2443 ◽  
Author(s):  
Savas Ceylan ◽  
Ihsan Anik ◽  
Kenan Koc ◽  
Sibel Kokturk ◽  
Sureyya Ceylan ◽  
...  
Keyword(s):  
Extracellular Matrix ◽  
Pituitary Gland ◽  
Microsurgical Anatomy

The Medial Wall of the Cavernous Sinus: Microsurgical Anatomy

Neurosurgery ◽  
2004 ◽  
Vol 55 (1) ◽  
pp. 179-190 ◽  
Author(s):  
Alexandre Yasuda ◽  
Alvaro Campero ◽  
Carolina Martins ◽  
Albert L. Rhoton ◽  
Guilherme C. Ribas
Keyword(s):  
Pituitary Gland ◽  
Cavernous Sinus ◽  
Thin Sheet ◽  
Single Layer ◽  
Lateral Wall ◽  
The Body ◽  
Medial Wall ◽  
Microsurgical Anatomy ◽  
Pituitary Fossa ◽  
Adjacent Structures

Abstract OBJECTIVE: This study was conducted to clarify the boundaries, relationships, and components of the medial wall of the cavernous sinus (CS). METHODS: Forty CSs, examined under ×3 to ×40 magnification, were dissected from lateral to medial in a stepwise fashion to expose the medial wall. Four CSs were dissected starting from the midline to lateral. RESULTS: The medial wall of the CS has two parts: sellar and sphenoidal. The sellar part is a thin sheet that separates the pituitary fossa from the venous spaces in the CS. This part, although thin, provided a barrier without perforations or defects in all cadaveric specimens studied. The sphenoidal part is formed by the dura lining the carotid sulcus on the body of the sphenoid bone. In all of the cadaveric specimens, the medial wall seemed to be formed by a single layer of dura that could not be separated easily into two layers as could the lateral wall. The intracavernous carotid was determined to be in direct contact with the pituitary gland, being separated from it by only the thin sellar part of the medial wall in 52.5% of cases. In 39 of 40 CSs, the venous plexus and spaces in the CS extended into the narrow space between the intracavernous carotid and the dura lining the carotid sulcus, which forms the sphenoidal part of the medial wall. The lateral surface of the pituitary gland was divided axially into superior, middle and inferior thirds. The intracavernous carotid coursed lateral to some part of all the superior, middle, and inferior thirds in 27.5% of the CSs, along the inferior and middle thirds in 32.5%, along only the inferior third in 35%, and below the level of the gland and sellar floor in 5%. In 18 of the 40 CSs, the pituitary gland displaced the sellar part of the medial wall laterally and rested against the intracavernous carotid, and in 6 there was a tongue-like lateral protrusion of the gland that extended around a portion of the wall of the intracavernous carotid. No defects were observed in the sellar part of the medial wall, even in the presence of these protrusions. CONCLUSION: The CS has an identifiable medial wall that separates the CS from the sella and capsule of the pituitary gland. The medial wall has two segments, sellar and sphenoidal, and is formed by just one layer of dura that cannot be separated into two layers as can the lateral wall of the CS. In this study, the relationships between the medial wall and adjacent structures demonstrated a marked variability.

Microsurgical Anatomy of the Upper Cranial Nerves in the Sellar Region

1991 ◽  
pp. 154-159
Author(s):  
S. C. Ohaegbulam ◽  
J. I. Ausman ◽  
M. Dujovny ◽  
F. G. Diaz ◽  
H. G. Mirchandani
Keyword(s):  
Cranial Nerves ◽  
Microsurgical Anatomy ◽  
Sellar Region

Microsurgical anatomy of the sellar region

1975 ◽  
Vol 43 (3) ◽  
pp. 288-298 ◽  
Author(s):  
Wade H. Renn ◽  
Albert L. Rhoton
Keyword(s):  
Sphenoid Sinus ◽  
Carotid Arteries ◽  
Sella Turcica ◽  
Acute Angle ◽  
Surgical Approaches ◽  
Microsurgical Anatomy ◽  
Optic Nerves ◽  
Content Type ◽  
Sellar Floor ◽  
Fine Print

✓ Fifty adult sellae and surrounding structures were examined under magnification with special attention given to anatomical variants important to the transfrontal and transsphenoidal surgical approaches. The discovered variants considered disadvantageous to the transsphenoidal approach were as follows: 1) large anterior intercavernous sinuses extending anterior to the gland just posterior to the anterior sellar wall in 10%; 2) a thin diaphragm in 62%, or a diaphragm with a large opening in 56%; 3) carotid arteries exposed in the sphenoid sinus with no bone over them in 4%; 4) carotid arteries that approach within 4 mm of midline within the sella in 10%; 5) optic canals with bone defects exposing the optic nerves in the sphenoid sinus in 4%; 6) a thick sellar floor in 18%; 7) sphenoid sinuses with no major septum in 28% or a sinus with the major septum well off midline in 47%; and 8) a presellar type of sphenoid sinus with no obvious bulge of the sellar floor into the sphenoid sinus in 20%. Variants considered disadvantageous to the transfrontal approach were found as follows: 1) a prefixed chiasm in 10% and a normal chiasm with 2 mm or less between the chiasm and tuberculum sellae in 14%; 2) an acute angle between the optic nerves as they entered the chiasm in 25%; 3) a prominent tuberculum sella protruding above a line connecting the optic nerves as they entered the optic canals in 44%; and 4) carotid arteries approaching within 4 mm of midline within or above the sella turcica in 12%.

scholarly journals Proton Beam Therapy in the Treatment of Periorbital Malignancies

2021 ◽  
Vol 7 (4) ◽  
pp. 42-51
Author(s):  
Nicholas J. Damico ◽  
Anna K. Wu ◽  
Michael Z. Kharouta ◽  
Tal Eitan ◽  
Rajesh Pidikiti ◽  
...  
Keyword(s):  
Overall Survival ◽  
Radiation Therapy ◽  
Pituitary Gland ◽  
Proton Beam ◽  
Organs At Risk ◽  
Proton Beam Therapy ◽  
Lacrimal Glands ◽  
Optic Nerves ◽  
Volumetric Arc Therapy ◽  
Arc Therapy

Abstract Purpose Periorbital tumor location presents a significant challenge with 3-dimensional conformal radiation therapy or intensity modulated radiation therapy due to high tumor dose needed in the setting of close proximity to orbital structures with lower tolerance. Proton beam therapy (PBT) is felt to be an effective modality in such cases due to its sharp dose gradient. Materials and Methods We reviewed our institutional PBT registry and identified 17 patients with tumor epicenters within 2 cm of the eye and optic apparatus treated with passive scatter PBT with comparison volumetric arc therapy plans available. Maximum and mean doses to organs at risk of interest, including optic nerves, optic chiasm, lens, eye ball, pituitary, cochlea, lacrimal gland, and surrounding brain, were compared using the paired Wilcoxon signed rank test. Overall survival was determined using the Kaplan-Meier method. Results Median age was 67. Median follow-up was 19.7 months. Fourteen patients underwent upfront resection and received postoperative radiation and 3 received definitive radiation. One patient received elective neck radiation, 2 underwent reirradiation, and 3 had concurrent chemotherapy. There was a statistically significant reduction in mean dose to the optic nerves and chiasm, brain, pituitary gland, lacrimal glands, and cochlea as well as in the maximum dose to the optic nerves and chiasm, pituitary gland, lacrimal glands, and cochlea with PBT. The 18-month cumulative incidence of local failure was 19.1% and 1-year overall survival was 80.9%. Conclusion Proton beam therapy resulted in significant dose reductions to several periorbital and optic structures compared with volumetric arc therapy. Proton beam therapy appears to be the optimal radiation modality in such cases to minimize risk of toxicity to periorbital organs at risk.

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