Anatomy and embryology of the lateral sellar compartment (cavernous sinus) medial wall

Kehrli, P.; Ali, Mohamed; Reis, M.; Maillot, Cédric; Dietemann, Jean-Louis; Dujovny, Manuel; Ausman, James I.

doi:10.1080/01616412.1998.11740568

Cited by 58 publications

(42 citation statements)

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“…In contrast to other intracranial dural venous sinuses, the CS is located extradurally, not between the periosteal and meningeal layers. 17,18 Due to its many routes of venous drainage, the presenting symptoms and signs of a CS DAVF are often benign. 46 These symptoms include blurred vision, bruit, diplopia, exophthalmos, chemosis, and glaucoma.…”

Section: Comparison Of Cs Davfs and Ncs Davfsmentioning

confidence: 99%

Stereotactic radiosurgery for intracranial dural arteriovenous fistulas: a systematic review

Chen¹,

Lee

Ding³

et al. 2015

JNS

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C urrent treatment strategies for intracranial dural arteriovenous fistulas (DAVFs) include microsurgical ligation, transarterial or transvenous embolization, stereotactic radiosurgery (SRS), and various combinations of these therapeutic options. Endovascular therapy, most commonly performed via transvenous routes, has become the preferred treatment approach for DAVFs. 27,44,48 Due to the immediate obliteration that can be achieved with endovascular or surgical occlusion, SRS is typically reserved for lesions that cannot be obliterated with endovascular or surgical approaches, or for patients who pose a high surgical risk due to medical comorbidities. Therefore, published SRS series for DAVFs remain relatively few and comprise mostly retrospective, single-center studies.In this systematic review, we evaluate the obliteration rate of DAVFs in patients treated with SRS. We also compare obliteration rates between cavernous sinus (CS) and noncavernous sinus (NCS) DAVFs, and between DAVFs with and without cortical venous drainage (CVD), by using available data in the literature. Methods inclusion CriteriaIn our attempt to balance between the largest possible patient population and a relatively homogeneous cohort, the following inclusion criteria for this systematic review were devised: 1) the study must contain at least 5 patients abbreviatioNs AVM = arteriovenous malformation; CS = cavernous sinus; CVD = cortical venous drainage; DAVF = dural arteriovenous fistula; GKS = Gamma Knife surgery; LINAC = linear accelerator; NCS = noncavernous sinus; SRS = stereotactic radiosurgery; TSS = transverse and sigmoid sinus. obJeCt The goal of this study was to evaluate the obliteration rate of intracranial dural arteriovenous fistulas (DAVFs) in patients treated with stereotactic radiosurgery (SRS), and to compare obliteration rates between cavernous sinus (CS) and noncavernous sinus (NCS) DAVFs, and between DAVFs with and without cortical venous drainage (CVD). Methods A systematic literature review was performed using PubMed. The CS DAVFs and the NCS DAVFs were categorized using the Barrow and Borden classification systems, respectively. The DAVFs were also categorized by location and by the presence of CVD. Statistical analyses of pooled data were conducted to assess complete obliteration rates in CS and NCS DAVFs, and in DAVFs with and without CVD. results Nineteen studies were included, comprising 729 patients harboring 743 DAVFs treated with SRS. The mean obliteration rate was 63% (95% CI 52.4%-73.6%). Complete obliteration for CS and NCS DAVFs was achieved in 73% and 58% of patients, respectively. No significant difference in obliteration rates between CS and NCS DAVFs was found (OR 1.72, 95% CI 0.66-4.46; p = 0.27). Complete obliteration in DAVFs with and without CVD was observed in 56% and 75% of patients, respectively. A significantly higher obliteration rate was observed in DAVFs without CVD compared with DAVFs with CVD (OR 2.37, 95% CI 1.07-5.28; p = 0.03). CoNClusioNs Treatment with SRS offers favorable rates of D...

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Section: Comparison Of Cs Davfs and Ncs Davfsmentioning

confidence: 99%

Stereotactic radiosurgery for intracranial dural arteriovenous fistulas: a systematic review

Chen¹,

Lee

Ding³

et al. 2015

JNS

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“…Studies of the relationship of the internal carotid artery to the cavernous sinus show that the artery is surrounded by a plexiform arrangement of dural sinuses (Harris and Rhoton, 1976;Taptas, 1982;Kehrli et al, 1998). The multiple dural sinuses surrounding the middle meningeal artery in our cross-sections could be explained by a similar arrangement, albeit on a smaller scale.…”

Section: Anatomy At the Level Of The Foramen Spinosummentioning

confidence: 64%

Middle meningeal artery hemorrhage: An incorrect name

et al. 2006

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Extradural hemorrhage is most commonly assumed to result from a middle meningeal artery rupture. This article challenges that assumption. The meningeal vasculature of 29 cadaveric specimens was examined macroscopically and microscopically at the level of the greater wing of the sphenoid bone and foramen spinosum. It was observed that the middle meningeal artery is accompanied by a pair of dural sinuses throughout the majority of its course, thus making exclusively arterial rupture an anatomical improbability. Furthermore, as these dural sinuses pass caudally through the foramen spinosum with the middle meningeal artery, they were seen to diverge to form a plexiform arrangement around the artery. This has not been reported before.

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“…A variety of different surgical approaches to this area have been described (Fahlbusch and Buchfelder, 1988;Origitano et al, 1992;Fraioli et al, 1995;Dolenc, 1997;Kitano and Taneda, 2001;Liu et al, 2001;Day, 2003), however, only a few studies have focused on the medial venous space and the medial wall of the CS (MWCS). The observations documented in these latter reports have been inconsistent (Chi and Lee, 1980;Inoue et al, 1990;Knosp et al, 1993;Ciric, 1997;Kehrli et al, 1998;Domingues et al, 1999;Yokoyama et al, 2001).…”

Section: Introductionmentioning

confidence: 91%

“…The literature on pituitary tumor invasion of the CS raises questions about the thickness of the MWCS, suggests possible defective sites in this wall, and even debates the existence of a medial wall (Kawase et al, 1996;Dietemann et al, 1998;Kehrli et al, 1998;Romano et al, 2001;Yokoyama et al, 2001). Complete quantitative descriptions and histological verification of the anatomy of the MWCS are lacking Yokoyama et al, 2001).…”

Section: Introductionmentioning

confidence: 96%

Medial portion of the cavernous sinus: Quantitative analysis of the medial wall

et al. 2005

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Pituitary tumors invade the cavernous sinus via the medial wall. Researchers have speculated that this wall is composed of dura and that substances secreted by tumors might damage this barrier. In contrast to the lateral wall, little is known about the structure of the medial wall of the cavernous sinus (MWCS). This study provides the first detailed quantitative (thickness) and qualitative (histological) assessment of the MWCS. Eighteen sellar-parasellar tissue blocks were obtained from adult human autopsies. Ten specimens were used for microsurgical dissection and macroscopic anatomical description. Eight specimens were used for histopathological study and for recording computer measurements of MWCS thickness. Each of these eight specimens was divided into three approximately equal-sized pieces, with cuts made in the coronal plane from posterior to anterior starting at the anterior level of the pituitary stalk. Wall thicknesses were compared in the three different regions (posterior, middle, anterior), and also on the left vs. the right sides. The investigations showed that the MWCS is a distinct dural layer that forms a barrier between the medial venous space of the cavernous sinus and the pituitary gland. The mean thickness of the 48 total (left and right) MWCS observed in the 24 sections examined was 0.195 +/- 0.066 mm (range = 0.080-0.387 mm). This wall is composed of loosely arranged collagen fibers that comprise a specific layer known as "meningeal dura." The posterior third of the MWCS was significantly thinner than the middle third (P = 0.0014) or anterior third (P = 0.0001). No macro- or microscopic defects were observed in any of the MWCS in the 18 specimens. The thinness of the posterior MWCS suggests that this is the most likely path for extension of pituitary tumors into the cavernous sinus.

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Anatomy and embryology of the lateral sellar compartment (cavernous sinus) medial wall

Cited by 58 publications

References 0 publications

Stereotactic radiosurgery for intracranial dural arteriovenous fistulas: a systematic review

Stereotactic radiosurgery for intracranial dural arteriovenous fistulas: a systematic review

Middle meningeal artery hemorrhage: An incorrect name

Medial portion of the cavernous sinus: Quantitative analysis of the medial wall

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