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Neurosurgery: Posterior fossa surgery
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Geriatric Neuroanesthesia, 2019
The posterior cranial fossa is bordered anteriorly and laterally by the superior border of the petrous temporal bone, anteriorly and medially by the dorsum sellae of sphenoid bone, superiorly by the tentorium cerebelli (a wide tent-shaped fold of the dura which lies between the occipital lobe superiorly and the cerebellum inferiorly) and inferiorly by the foramen magnum. It primarily houses the brainstem (midbrain, pons and upper medulla), cerebellar hemispheres (essential for motor coordination) and the vertebrobasilar vascular system.
Give an account of the origin, course, relations and functions of the sixth cranial nerve
Published in Nathaniel Knox Cartwright, Petros Carvounis, Short Answer Questions for the MRCOphth Part 1, 2018
Nathaniel Knox Cartwright, Petros Carvounis
It emerges into the subarachnoid space from the anterior surface of the brainstem in a groove between the lower border of the pons and the medulla oblongata before running upwards, forwards and laterally to pierce the dura lateral to the dorsum sellae of the sphenoid bone.
Pituitary surgery
Published in Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni, Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
Valentina Pennacchietti, Nelson M. Oyesiku
The nasal cavity provides access to this space, because the sphenoid bone connects it to the pituitary gland above. The carotid arteries are in close relationship to the sphenoid bone, creating an impression in the lateral wall of the sphenoid sinus. Also, both cavernous sinuses lie laterally to the sphenoid bone. The pituitary gland rests in the center of the bone, the sella turcica, limited anteriorly by the tuberculum sellae and posteriorly by the dorsum sellae. The sphenoid sinus is an air cavity inside the sphenoid body. It separates the cavernous sinuses, the cavernous segments of the carotid arteries, the optic, extraocular, and trigeminal nerves, and the pituitary gland from the nasal cavity (Figure 37.4). The sella turcica is separated from the rest of the brain by the diaphragma sellae, a membrane that covers the pituitary gland, except for a small opening in its center for the pituitary stalk.
A Case Report of Bilateral Abducens Palsy in the Setting of Clival Fracture – Recovery Related to Pathophysiological Basis of Injury
Published in Neuro-Ophthalmology, 2021
Stefan Dimou, Lobna Alukaidey, Girish Nair
Computed tomography of the head revealed a transverse, non-displaced clival fracture extending to both carotid canals and the dorsum sellae, small volume pneumocephalus and only a trace of subarachnoid haemorrhage (Figure 2). No apparent cause for the ophthalmoplegia was found. Magnetic resonance imaging (MRI) of the head was subsequently performed, depicting, at the level of the prepontine cistern, an intact right abducens nerve (Figure 3). Its left-sided counterpart, however, was not seen. The clival fracture showed close association with the likely course of each nerve. No parenchymal injury was seen within the brainstem that would otherwise explain the patient’s ophthalmoplegia.
From above or from below? That is the question. Comparison of the supraorbital approach with the endonasal approach. A cadaveric study
Published in British Journal of Neurosurgery, 2018
Simone Peraio, Paul Chumas, Paul Nix, Nick Phillips, Atul Tyagi
We started our dissection from the right nostril. After introducing the rigid endoscope through the nostril, the inferior turbinate was identified and followed until the choana. The middle turbinate was removed using endoscopic scissors and the sphenoid ostium was identified. In the contralateral nostril, the middle turbinate was displaced laterally to make more room to allow access with instruments. A portion of the nasal septum anteriorly to the vomer was resected allowing bilateral access. The sphenoid sinus ostiums were opened using Kerrison rongeurs and anterior sphenoidotomy was performed. The mucosa of the sphenoid sinus was removed. The sphenoid septum was removed, using a drill to make the internal surface of the sphenoid sinus smooth. The floor of the sella, the two carotid protuberances, the medial aspect of the optic canals, and the upper clivus were identified (Figure 1(A)). We drilled the anterior aspect of the sella and then enlarged the bone opening with the Kerrison rongeurs (Figure 1(B)). We drilled the medial aspect of the optic canal in order to decompress the nerve (Figure 1(C)). We then removed the planum ethmoidalis starting from the tuberculum sellae, using Kerrison rongeurs and high speed drill. We measured the planum opening, which was 2 cm wide and 3 cm long. Using a high speed drill we removed the dorsum sellae and the superior two thirds of the clivus. We opened the dura of the sellar floor and then we proceeded anteriorly (Figure 1(D)). This gave us a wide exposure of the pituitary gland, the optic chiasm, the infrachiasmatic cistern and the pituitary stalk, the oculomotor nerves, the basal pons, the upper trunk of the basilar artery, the superior cerebellar arteries, the posterior cerebral arteries, the posterior communicating arteries and the basilar bifurcation.
Prognosis of dolichoectasia in non-cardioembolic transient ischemic attack and minor stroke
Published in Neurological Research, 2018
Xinmiao Zhang, Jing Jing, Xingquan Zhao, Liping Liu, Xia Meng, Anxin Wang, Yuesong Pan, David Wang, Yilong Wang, Yongjun Wang
As Table 1 shows, the mean measured BA diameters were higher in the IADE (+) group than those in the IADE (–) group (4.92 mm vs. 3.46 mm, p < 0.001). The height of bifurcation of the BA was above the suprasellar cistern in 92.9% of patients in the IADE (+) group and 27.4% of those in the IADE (–) group (p < 0.001). The transverse position of the BA was lateral to the margin of the clivus or dorsum sellae in 31.7% of patients in the IADE (+) group and 8.7% of patients in the IADE (–) group (p < 0.001).