ABSTRACT
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.
Subject(s)
Humans , Cavernous Sinus/anatomy & histology , Cavernous Sinus/surgery , Minimally Invasive Surgical Procedures/methods , Endoscopy/methods , Neuroendoscopy/methods , Microsurgery/methodsABSTRACT
The pterional approach was described in the 1970s and has become the most utilized cranial approach with many variations described, including the minipterional technique. Although described recently as an alternative to the pterional approach for anterior circulation aneurysms, to our knowledge a large series of cases using the minipterional approach in both ruptured and unruptured aneurysms has not been described. We present our clinical experience with the minipterional craniotomy in more than 100 ruptured and unruptured anterior circulation aneurysms. The results of 86 consecutive patients with 102 ruptured non-giant, anterior circulation aneurysms treated with early surgery utilizing the minipterional craniotomy were analyzed. Postoperative angiography was carried out in all cases. Outcome results were classified as excellent in 67 (77.9%), and good in seven (8.1%), while 16 (13.9%) patients died. The minipterional technique provides adequate surgical exposure and excellent outcomes for both ruptured and unruptured anterior circulation aneurysm clipping. It constitutes a safe and effective alternative to the pterional approach, with equivalent or potentially better aesthetic and functional outcomes.
Subject(s)
Craniotomy/methods , Intracranial Aneurysm/surgery , Adult , Aged , Aged, 80 and over , Aneurysm, Ruptured/surgery , Female , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
A hipófise e a região selar podem ser acometidas por uma série de tumores. Nesse contexto, metástase é um diagnóstico diferencial raro, porém plausível. O diagnóstico de metástase para região selar é desafiador. Assim, espessamento da haste hipofisária, invasão de seio cavernoso e esclerose ao redor da sela são detalhes sutis que, apesar de não serem conclusivos, podem sugerir esse diagnóstico. Neste artigo os autores descrevem um caso de um paciente sem antecedentes oncológicos e com RM e TC sugestivas de macroadenoma hipofisário. Inesperadamente, a lesão era um adenocarcinoma metastático de cólon. Metástases cerebrais de câncer colorretal são raras, principalmente para região selar e normalmente aparecem após o diagnóstico da lesão primária. Nosso objetivo é descrever um caso de metástase de cólon para região selar e sua evolução e rever dados de literatura.
The pituitary gland and sellar region may be a site for a number of tumors. In this context a rare but feasible differential diagnosis is metastasis. The diagnosis of metastasis in the sellar region is challenging. Therefore, thickening of the pituitary stalk, invasion of the cavernous sinus and sclerosis around the sella, although not conclusive, may suggest this diagnosis. In this article the authors describe a case of a patient without any oncological history and with MRI and CT-scan suggestive of pituitary macroadenoma. Surprisingly the tumor was an metastatic colonic adenocarcinoma. Colonic and rectal metastasis to the brain are rare, particularly to the sellar region and normally appear after the primary lesion is already diagnosed. Our goal is to describe a case of colonic metastasis to the sellar region and its evolution and review literature data.
