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Neurosurgery: Neuroendocrine lesions
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Geriatric Neuroanesthesia, 2019
The pituitary gland is situated in a saddle-shaped depression (sella turcica) in the sphenoid bone, also known as hypophyseal fossa (6). Boundaries of the hypophyseal fossa are formed by tuberculum sellae (elevation in the sphenoid bone) anteriorly, dorsum sellae posteriorly, the sphenoid sinus inferiorly, and folds of dura joining the anterior and posterior clinoid processes (diaphragmatic sella) superiorly. Dural reflections enclosing cavernous sinuses form the lateral wall of hypophyseal fossa. The carotid arteries and cranial nerves (III, IV, VI, V1, and V2) traverse through these sinuses (Figure 8.1).
Developmental Anatomy of the Pituitary Fossa
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
The diaphragmatica sella is a sheet of dura mater that forms the roof of the sella turcica. This small, flat, horizontal circular sheet covers over the fossa between the clinoid processes and is continuous with the roof of the cavernous sinus. There is a central defect in the diaphragm called the foramen diaphragmatis to allow through the pituitary stalk or infundibulum. It is of variable diameter up to 5 mm.12 In the region of the foramen of the dura, arachnoid and pia mater fuse with each other and with the capsule of the pituitary gland to form one fibrous layer that lines the hypophyseal fossa. In the fossa it is not possible to differentiate the fibrous layers and there are no subdural or subarachnoid spaces. Therefore there is no cerebrospinal fluid (CSF) in the normal pituitary fossa. The diaphragmatica sella separates the contents of the pituitary fossa from the CSF in the region of the foramen. The barrier may be very thin and consist of only arachnoid mater.13
Anatomy for neurotrauma
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Anesthesia for Neurotrauma, 2018
Vasudha Singhal, Sarabpreet Singh
The sella turcica is a saddle-shaped bony formation on the upper surface of the body of sphenoid, surrounded by the anterior and posterior clinoid processes. Its anterior edge is formed by a bony prominence known as the tuberculum sella, which continues with the prechiasmatic sulcus. The median depression housing the pituitary gland is the hypophysial fossa. The posterior boundary of the sella presents a vertical pillar of bone called the dorsum sella. The sigmoid groove for the internal carotid artery lies in this region, as it traverses the petrous apex through the cavernous sinus. A fold of dura attached to the anterior and posterior clinoid processes, forming a roof over the pituitary fossa, is the diaphragma sellae. The cavernous sinus lies lateral to the pituitary fossa.
Quality of life outcomes after transnasal endoscopic pituitary surgery using the Glasgow Benefit Inventory
Published in British Journal of Neurosurgery, 2022
Frederick R. Green, Matthew I. Sanders, Paul Davies, Showkat Mirza, Saurabh Sinha
To the authors’ knowledge this is the first application of the GBI to transnasal endoscopic pituitary surgery. Authors using the Short Form-36 (SF-36) questionnaire have found that patients who underwent this surgery reported moderate improvement in general health after a 2-week post-operative phase, but either very minor improvement or even decline in physical functioning at 6 months.2,12 Preoperative visual loss has been independently associated with improved SF-36 scores.2,12 Authors using the Anterior Skull Base Questionnaire (ASBQ) for endoscopic approach to all anterior skull base tumours have found generally positive scores but only after at least 3 months (with ranges up to 1 year) post-operatively,3,4,13–15 and only after 6 months when using SNOT-22 (24 months in one case).3,4,14 One author using the Rhinosinusitis Disability Index (RSDI) for endoscopic pituitary surgery found no significant change in score in a cohort of 50 patients.16 One author used GBI components but after a subcranial approach to the hypophyseal fossa.17
Retinal nerve fibre and ganglion cell inner plexiform layer analysis by optical coherence tomography in asymptomatic empty sella patients
Published in International Journal of Neuroscience, 2020
Ali Yilmaz, Mustafa Gok, Hilal Altas, Timur Yildirim, Sukran Kaygisiz, Hasan Serdar Isik
Anatomic variations and incomplete development of the sellar diaphragm are the most commonly accepted underlying pathologies in ES. The aforementioned anomalies open up a “free pathway” between the chiasmatic cistern and hypophyseal fossa, and the pulsatile action of cerebrospinal fluid (CSF) causes herniation of suprasellar structures toward the sella turcica. In this progressive process, compression of the pituitary gland and rhinorrhoea due to sellar base bone erosion may occur [6]. These pathophysiological events are reflected in the clinical setting as headaches, visual disturbances, hypophyseal hormonal anomalies, and rhinorrhoea (i.e. primary empty sella [PES] syndrome). Pituitary gland radiotherapy and surgery are the most common causes of secondary ES syndrome [7]. Visual loss and rhinorrhoea are indications for surgical interventions in PES patients.