Is there a dural wall between the cavernous sinus and the pituitary fossa? Anatomical and MRI findings

Dietemann, J L; Kehrli, P.; Maillot, Cédric; Diniz, Renata Lopes Furletti Caldeira; Reis, M.; Neugroschl, Carine; Vinclair, L.

doi:10.1007/s002340050653

Cited by 69 publications

(47 citation statements)

References 12 publications

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“…Of these, four (172 samples, 44.7% of all samples included in this review) referred to the medial wall of the CS as a loose fibrous structure [4,9], as its own pituitary capsule of fine collagen fibers [28], or as two layers composed of the lateral part of the pituitary capsule and the fibrous layer [21]. Ten studies (213 samples, 55.3% of all samples included in this review) Fig.…”

Section: Resultsmentioning

confidence: 99%

“…With regard to the methodology, in those studies that presented results confirming a fibrous tissue separating the pituitary fossa from the lateral sellar compartment, all of them utilized magnetic resonance imaging (MRI) [4,9,28] and/or histological staining methods (the Van Gieson [28], hematoxylin and eosin, and/or Masson's trichrome [4,9,21]). Of these studies, three included histological sections and cadaveric dissection under surgical microscope [4,9,21], while in one study, transphenoidal surgery was assessed by the Mann-Whitney U test in cases and controls beyond the histological section [28].…”

Section: Resultsmentioning

confidence: 99%

“…2). However, some recent reports suggest that there is not a medial dural wall-rather, there exists a loose fibrous tissue that separates the pituitary capsule [4,9], or merely its own capsule formed by fine collagen fibers that separate the gland [28].…”

Section: Introductionmentioning

confidence: 97%

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Cavernous sinus medial wall: dural or fibrous layer? Systematic review of the literature

et al. 2011

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The cavernous sinus (CS) has one of the most complex anatomical networks of the skull base and because of the diversity of its contents is involved in many pathological processes. Nevertheless, anatomical literature concerning the CS is still controversial, so a systematic literature review was performed to find out the microanatomy of the medial wall of the CS and its clinical importance on sellar pathologies. Experimental studies from English-language literature between 1996 and 2010 were identified in MEDLINE, LILACS, and Cochrane databases. After analysis, two tables were prepared exhibiting the major points of each article. Fourteen experimental studies were included in the tables. Four studies concluded that the medial wall of the CS is composed of a loose, fibrous structure, and the remaining ten presumed that the medial wall is formed by a dural layer that constitutes the lateral wall of the sella. The lack of definition standards and of methodological criteria led to variation in the results among different studies. Thus, this hindered results comparison, possibly explaining the different observations.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Cavernous sinus medial wall: dural or fibrous layer? Systematic review of the literature

et al. 2011

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“…Firstly, Bleys et al (19) reported the existence of the lateral sellar nerve plexus within the cavernous sinus, which is a distribution center for visceromotor and sensory nerves innervating cerebral arteries, orbital structures and the dura mater. Notably, Dietemann et al (20) have revealed that there is not a clear separation between the pituitary fossa and the cavernous sinus, so there is a potential deficiency in the medial wall of the cavernous sinus. Certain authors (4,12) propose that tumors originating from the lateral sellar nerve plexus may extend through the the medial wall of the cavernous sinus to form an intrasellar schwannoma.…”

Section: Discussionmentioning

confidence: 99%

Computed tomography and magnetic resonance imaging findings of intrasellar schwannoma: A case report and literature review

Liu

Ouyang

2016

Oncology Letters

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Abstract. Intrasellar schwannoma is extremely rare, and only a few cases have been reported in the literature to date. In the present study, the clinical, radiological and pathological features of a 50-year-old male patient with primary intrasellar schwannoma are presented. The patient presented with decreased visual acuity, and a subsequent computed tomography (CT) scan revealed a giant well-demarcated intrasellar mass with suprasellar extension, without cavernous sinus invasion. The lesion was slightly hyperdense with heterogeneous enhancement. On magnetic resonance imaging (MRI), the mass was isointense on T1 weighted images (WI), and slightly hyperintense on T2WI, with significant heterogeneous enhancement. Previous literature was reviewed to summarize the CT and MRI characteristics of intrasellar schwannoma. Despite the rarity of this tumor, intrasellar schwannoma must be included in the differential diagnosis of intrasellar lesions.

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“…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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Is there a dural wall between the cavernous sinus and the pituitary fossa? Anatomical and MRI findings

Cited by 69 publications

References 12 publications

Cavernous sinus medial wall: dural or fibrous layer? Systematic review of the literature

Cavernous sinus medial wall: dural or fibrous layer? Systematic review of the literature

Computed tomography and magnetic resonance imaging findings of intrasellar schwannoma: A case report and literature review

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

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