Anatomy for neurotrauma
Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor in Essentials of Anesthesia for Neurotrauma, 2018
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.
Morphometries of Craniofacial Form
D. Dixon Andrew, A.N. Hoyte David, Ronning Olli in Fundamentals of Craniofacial Growth, 2017
A recent study applied EFF’s to characterize the shape of the cranial base in Macaca nemestrina (Lestrel et al., 1993). This study represents an extension of previous work using conventional FD’s (Lestrel and Sirianni, 1982). Statistically significant changes were found for both sex and age. The age changes consisted of a gradual lengthening in the anteroposterior direction with a simultaneous narrowing in the supero-inferior direction. An elongation of the dorsal clivus as well as an anterior migration of the hypophysial fossa was observed. Whether these same changes can be documented in human data remains to be evaluated and work is underway. Current work has focused on precisely delineating the location of 2-D shape changes in the lateral view of the cranial base in shunt-treated hydrocephalics compared to normal age- and sex-matched controls (Lestrel et al., 1994).
Developmental Anatomy of the Pituitary Fossa
John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie in 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
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
Correlations between clinical hormone change and pathological features of pituicytoma
Published in British Journal of Neurosurgery, 2018
Ting-Wei Chang, Ching-Yi Lee, Shih-Ming Jung, Hung-Yi Lai, Chun-Ting Chen, Mun-Chun Yeap, Chi-Cheng Chuang, Peng-Wei Hsu, Chen-Nen Chang, Po-Hsun Tu, Shih-Tseng Lee
During the study period, 1532 pituitary surgeries were performed at the Chang Gung Memorial Hospital Linko medical center using either the transsphenoid approach or the transcranial approach, and nine patients (0.59%) received a pathological diagnosis of pituicytoma. Two of the nine patients were excluded due to a lack of viable specimens for our IHC study. The seven remaining patients comprised one man and six women whose mean age was 41.86 years (range: 21–57 years) (Table 1). All of the patients’ lesions were located in the sella turcica without extrasellar extension, and had a maximum diameter on a single plane that ranged from 4 to 11.9 mm. One patient presented with bitemporal hemianopia; the other six all presented with hormone changes, namely hyperprolactinemia and galactorrhea (one patient), hypoprolactinemia (one patient), acromegaly (one patient), and Cushing disease that was diagnosed using the dexamethasone suppression test (three patients). All of the patient had tumour resection surgeries and the specimen sent for pathological examination included tumour and peri-tumoural pituitary gland tissue.
Richard Bright’s observations on diseases of the nervous system due to inflammation
Published in Journal of the History of the Neurosciences, 2018
Bright also documented cerebral venous thrombosis associated with cases of purulent otitis media: Autopsy of a 4-year-old girl showed that the “left lateral and the petrosal sinuses were filled with firm coagula” (Case 63, p. 121). Extensive purulent venous sinusitis was present in Case 66, a 37-year-old baker who developed severe pain in the one ear and shortly thereafter in both. He became delirious before being admitted to hospital and soon died. Autopsy showed that the lateral and the petrosal sinuses “were filled with ill-conditioned pus and this ran up to the sella turcica filling both the cavernous sinuses and the circular sinus round the sella turcica so that the pituitary gland was surrounded by pus.” The jugular vein on the same side contained “unhealthy green pus till it joined the subclavian” (p. 131). In Case 155, a boy with scrofulous tumors, “The longitudinal sinus felt thickened, and together with the lateral sinuses and some of the large connected veins was full of a soft red coagulum,” in addition to meningitis and tubercles in the brain.
Related Knowledge Centers
- Diaphragma Sellae
- Middle Cranial Fossa
- Skull
- Sphenoid Bone
- Pituitary Gland
- Clivus
- Chiasmatic Groove
- Tuberculum Sellae
- Dorsum Sellae
- Posterior Clinoid Processes