Microsurgical and Endoscopic Anatomy of the Cavernous Sinus

Objective To describe the endoscopic and microsurgical anatomy of the cavernous sinus (CS) with focus on the surgical landmarks in microsurgical anatomy. Materials and methods Ten formalin-fixed central skull base specimens (20 CSs) with silicone-injected carotid arteries were examined through an extended endoscopic transsphenoidal approach. Fifteen formalin-fixed heads were dissected to simulate the surgical position in CS approaches. Results Endoscopic access enables identification of the anterior and posterior surgical corridors. Structures within the CS and on its lateral wall could be visualized and studied, but none of the triangular areas relevant to the transcranial microsurgical anatomy were fully visible through the endoscopic approach. Conclusion The endoscopic approach to the CS is an important surgical technique for the treatment of pathological conditions that affect this region. Correlating endoscopic findings with the conventional (transcranial)microsurgical anatomy is a useful way of applying the established knowledge into a more recent operative technique. Endoscope can provide access to the CS and to the structures it harbors.

Multiplanar MRI imaging of sellar and parasellar lesions with clinical and pathological correlation

Background: Sellar and parasellar/ juxtasellar regions are complex areas of the brain, hold delicate neurovascular structures. A number of diseases that affect the pituitary-hypothalamic axis can have profound clinical, endocrinological as well as neurological consequences. Aim of this retrospective study was to identify the MR imaging characteristics and epidemiology of sellar and suprasellar lesions, to correlate the MRI findings with histopathological findings and to highlight the diagnostic superiority of MR imaging.Methods: Author studied the records of 65 patients with sellar and suprasellar lesions for which preoperative MR imaging films or reports were available. Radiological appearances were correlated with intraoperative findings and post-operative histopathology.Results: Majority of patients in this study belonged to the age group 21-40 years. Most common mass lesion found was pituitary macroadenoma comprising 58% of the total cases. The accuracy of MRI in diagnosing macroadenomas are 96.80%. MR was 87.50%accurate, in diagnosing craniopharyngioma. MR was 100% in diagnosing meningioma in our study.Conclusions: MRI is the modality for characterizing sellar and suprasellar lesions, morphology of lesions, nature of contrast material enhancement and extent of lesions. Hence MRI is the modality of choice for diagnosing sellar and suprasellar masses with high accuracy