Meningovenous Structures of the Petroclival Region: Clinical Importance for Surgery and Intravascular Surgery

Özveren, Mehmet Faik; Uchida, Koichi; Aiso, Sadakazu; Kawase, Takeshi

doi:10.1097/00006123-200204000-00027

Cited by 66 publications

(64 citation statements)

References 36 publications

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“…Direct contact of the CSF with cranial nerves extends inside their dural porus and sleeve presumably contributes to their nourishment (7,21). A space between the clivus dura mater and arachnoid membrane is located inside the dural sleeve, as was confirmed by our dissections, and histological section.…”

Section: Discussionsupporting

confidence: 72%

Subarachnoid, subdural and interdural spaces at the clival region: an anatomical study.

Ayberk¹,

Özveren²,

Aslan³

et al. 2011

Turkish Neurosurgery

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AIm:We aimed to show the significance of the anterior pontine membrane as a determining structure between the subdural and subarachnoid space in the clival region. mAterIAl and methOds: Five adult cadaver heads and five cerebral hemispheres were used. The skull vault and hemipheres were removed by sectioning through the pontomesencephalic junction. Five other heads hemispheres were removed but the arachnoid membrane was protected and the cerebral side of the clival dura mater was dissected. In another specimen, the dural porus of the abducens nerve was sectioned for histological evaluation. Three cases of hematoma at the clivus were presented to support our findings. results:The anterior pontine membrane is the arachnoid membrane forming the anterior wall of the prepontine cistern with its lateral extension at the skull base. This membrane forms the subdural and subarachnoid spaces by forming a barrier between the clival dura mater and neurovascular structures of the brainstem. There were rigid fibrous trabeculations between both cerebral and periosteal dural layers forming the basilar plexus as the interdural space in the clivus. COnClusIOn:The anterior pontine membrane separates the subdural and subarachnoid spaces at the clival region. The hematomas of the clival region require to be evaluated with consideration given to the existance of the subdural space.KeywOrds: Anterior pontine membrane, Arachnoid, Clivus, Interdural space ÖZ AmAÇ: Bu çalışmada, klival bölgedeki subdural ve subaraknoid mesafenin belirlenmesinde anterior pontin membranın önemini göstermek istedik. yÖntem ve GereÇ: Çalışmada beş yetişkin kadavranın kafatası ve beş serebral hemisfer kullanılmıştır. Kafatası ve hemisferler pontomezensefalik bileşke boyunca kesilerek çıkarılmıştır. Diğer beş hemisfer, araknoid membran korunarak çıkarılmış ve klival duramaterin serebral kısmı diseke edilmiştir. Bir başka spesmende, abdusens siniri dural porusu civarında histolojik kesit almak için kesilmiştir. Bulguları desteklemek için üç klival hematom vakası sunulmuştur.BulGulAr: Anterior pontin membran, prepontin sisternin anterior duvarını oluşturur ve kafa kaidesinin lateraline doğru uzanır. Bu membran, beyin sapının nörovaskuler yapıları ve klival dura dura mater arasında bariyer oluşturarak, subdural ve subaraknoid mesafenin oluşmasını sağlar. Klivusta baziler pleksusu oluşturan serebral ve periostal dural tabakalar arasında rijit fibröz trabekülasyonlar vardı. sOnuÇ: Anterior pontin membran, klival bölgede subdural ve subaraknoid mesafeleri ayırır. Klival bölgedeki hematomların, subdural mesafenin varlığı göz önüne alınarak değerlendirilmesi gerekir.

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Section: Discussionsupporting

confidence: 72%

Subarachnoid, subdural and interdural spaces at the clival region: an anatomical study.

Ayberk¹,

Özveren²,

Aslan³

et al. 2011

Turkish Neurosurgery

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“…In approximately 83% of cases, the adenoma is undiagnosed at the time of presentation. 15,16 Ninety percent of the patients in this series had undiagnosed pituitary adenomas. The majority of adenomas that undergo apoplexy are nonfunctioning macroadenomas.…”

Section: Discussionmentioning

confidence: 82%

“…15,16 The convex appearance of the retroclival hemorrhage in our series is suggestive of a subdural location, in which blood is located between the dura mater and the anterior prepontine membrane.…”

mentioning

confidence: 65%

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Spontaneous retroclival hematoma in pituitary apoplexy: case series

Azizyan¹,

Miller²,

Azzam³

et al. 2015

JNS

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OBJECT Pituitary apoplexy is a rare and potentially life-threatening disorder that is most commonly characterized by a combination of sudden headache, visual disturbance, and hypothalamic/hormonal dysfunction. In many cases, there is hemorrhagic infarction of an underlying pituitary adenoma. The resulting clinical symptoms are due to compression of the remaining pituitary, cavernous sinuses, or cranial nerves. However, there are only 2 case reports in the literature describing spontaneous retroclival expansion of hemorrhage secondary to pituitary apoplexy. Ten cases of this entity with a review of the literature are presented here. METHODS This is a single-institution retrospective review of 2598 patients with sellar and parasellar masses during the 10-year period between 1999 and 2009. The pituitary and brain MRI and MRI studies were reviewed by 2 neuroradiologists for evidence of apoplexy, with particular attention given to retroclival extension. RESULTS Eighteen patients (13 men and 5 women; mean age 54 years) were identified with presenting symptoms of sudden onset of headache and ophthalmoplegia, and laboratory findings consistent with pituitary apoplexy. Ten of these patients (8 men and 2 women; mean age 55 years) had imaging findings consistent with retroclival hematoma. CONCLUSIONS Retroclival hemorrhage was seen in the majority of cases of pituitary apoplexy (56%), suggesting that it is more common than previously thought.

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“…(1) We consider that the blood was not located in the interdural space, but in the subdural space of the clival region. The interdural space is located between the cerebral and periosteal dura mater layers [3], and constitutes the posterior part of the cavernous sinus, basilar plexus and inferior petrosal sinus structures at the petroclival region [2]. The cerebral and periosteal dural layers are attached to each other very firmly in the area without dural sinuses of the posterior fossa.…”

mentioning

confidence: 99%