The diaphragma sellae, diaphragm opening, and subdiaphragmatic cistern: an anatomical study using magnetic resonance imaging

Tsutsumi, Satoshi; Onο, Hideo; Yasumoto, Yukimasa; Ishii, Hisato

doi:10.1007/s00276-019-02184-0

Cited by 5 publications

(3 citation statements)

References 22 publications

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“…Their findings were confirmed by MRI-based studies. 28,29 This variability in the diameter of the diaphragmal opening likely explains the variable neck diameter in pituitary adenomas that extend into the suprasellar space and consequently the dumbbell shape. 30,31 Of note, our results revealed that the mean diaphragmal opening diameter showed no statistically significant difference between the tumor descent and nondescent groups.…”

Section: Potential Factors For Dspa Growthmentioning

confidence: 99%

Dumbbell-shaped pituitary adenomas: prognostic factors for prediction of tumor nondescent of the supradiaphragmal component from a multicenter series

Micko

Keritam

Marik

et al. 2022

Journal of Neurosurgery

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OBJECTIVE Dumbbell-shaped pituitary adenomas (DSPAs) are a subgroup of macroadenomas with suprasellar extension that are characterized by a smaller diameter at the level of the diaphragma sellae opening compared with the supradiaphragmal tumor component (SDTC). Hence, DSPAs may be particularly prone to a nondescending suprasellar tumor component and risk for residual tumor or postoperative bleeding. METHODS A multicenter retrospective cohort analysis of 99 patients with DSPA operated on via direct endoscopic endonasal transsphenoidal approach between 2011 and 2020 was conducted. Patient recruitment was performed at two tertiary care centers (Medical University of Vienna and University of Southern California) with expertise in endoscopic skull base surgery. DSPA was defined as having a smaller diameter at the level of the diaphragma sellae compared with the SDTC. RESULTS On preoperative MRI, all DSPAs were macroadenomas (maximum diameter range 17–71 mm, volume range 2–88 cm3). Tumor descent was found in 73 (74%) of 99 patients (group A), and nondescent in 26 (26%) of 99 patients (group B) intraoperatively. DSPAs in group A had a significantly smaller diameter (30 vs 42 mm, p < 0.001) and significantly smaller volume (10 vs 22 cm3, p < 0.001) than those in group B. The ratio of the minimum area at the level of the diaphragmal opening in comparison with the maximum area of the suprasellar tumor component ("neck-to-dome area") was significantly lower in group A than in group B (1.7 vs 2.7, p < 0.001). Receiver operating characteristic curve analysis revealed an area under the curve of 0.75 (95% CI 0.63–0.87). At a cutoff ratio of 1.9, the sensitivity and specificity for a nondescending suprasellar tumor component were 77% and 34%, respectively. CONCLUSIONS In the present study, the neck-to-dome area ratio was of prognostic value for prediction of intraoperative tumor nondescent in DSPAs operated on via a direct endonasal endoscopic approach. Pituitary adenoma SDTC nondescent carried the inherent risk of hemorrhagic transformation in all cases.

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Section: Potential Factors For Dspa Growthmentioning

confidence: 99%

Dumbbell-shaped pituitary adenomas: prognostic factors for prediction of tumor nondescent of the supradiaphragmal component from a multicenter series

Micko

Keritam

Marik

et al. 2022

Journal of Neurosurgery

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“…In the center, there is an opening that allows the pituitary stalk to pass from the hypothalamus to the posterior pituitary gland. This opening has been attributed varying terminology, including medial opening 2) , central opening 7,8) , foramen of DS 17) , and diaphragm opening 14,15) . Previous anatomical studies of the medial opening reported that the average maximal diameter of the medial opening was between 6.6 and 8.2 mm 2,8,17) , and most are located in the posterior middle portion of the DS 2,8) .…”

Section: Discussionmentioning

confidence: 99%

“…Accordingly, the demand for improving the precision of pituitary surgery and broadening accessible areas using the transspenoidal approach (TSA) has grown. Recent literature has provided a detailed https://doi.org/10.3340/jkns.2020.0140 anatomical dissection of the pituitary gland and cavernous sinus for achieving complete removal of the tumor with avoidance of complications 2,3,[7][8][9]11,14,15) . However, the issue of cerebrospinal fluid (CSF) leakage, which must be predicted preoperatively and adequately sealed, remains.…”

Section: Introductionmentioning

confidence: 99%

Predicting Arachnoid Membrane Descent in the Chiasmatic Cistern in the Treatment of Pituitary Macroadenoma

Lee

Shin

et al. 2021

J Korean Neurosurg Soc

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Preoperative prediction of the arachnoid membrane descent in pituitary surgery is useful for achieving gross total removal and avoiding cerebrospinal fluid leakage resulting from tearing of the arachnoid membrane in the chiasmatic cistern. In this study, we analyzed the patterns of arachnoid membrane descent during or after pituitary tumor surgery and identified the factors related to this descent. Methods : Analysis was restricted to pituitary macroadenomas not extending into the third ventricle or over the internal carotid artery. To minimize confounding factors, patients who underwent revision surgery, those who had a torn arachnoid during operation or small medial diaphragma sellae (DS) opening, and subtotal resections were excluded. We enrolled 41 consecutive patients in this retrospective analysis. The degree of arachnoid descent was categorized using intraoperative videos. Preoperative magnetic resonance findings, including tumor height, suprasellar extension, and variables including DS area and medial opening size, tumor composition, and displacement of the pituitary stalk and gland were evaluated to determine their correlations with arachnoid membrane descent. Results : Arachnoid membrane descent was significantly correlated with DS area and medial opening size. Based on T2-weighted images (T2WI) magnetic resonance (MR) images, tumor composition was significantly associated with arachnoid membrane descent. Other factors were not significantly correlated with arachnoid membrane descent. Conclusion : T2WI of tumor composition and preoperative MR imaging of DS area and medial opening provided valuable information regarding arachnoid membrane descent. These parameters may serve as fundamental measures to facilitate complete resection of pituitary macroadenomas.

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Anatomical variations of foramen of the diaphragma sellae and neighboring structures: a cadaveric study

Ay¹,

Akdag²,

Kilincli³

et al. 2023

Anat Sci Int

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The diaphragma sellae, diaphragm opening, and subdiaphragmatic cistern: an anatomical study using magnetic resonance imaging

Cited by 5 publications

References 22 publications

Dumbbell-shaped pituitary adenomas: prognostic factors for prediction of tumor nondescent of the supradiaphragmal component from a multicenter series

Dumbbell-shaped pituitary adenomas: prognostic factors for prediction of tumor nondescent of the supradiaphragmal component from a multicenter series

Predicting Arachnoid Membrane Descent in the Chiasmatic Cistern in the Treatment of Pituitary Macroadenoma

Anatomical variations of foramen of the diaphragma sellae and neighboring structures: a cadaveric study

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