Vascular Complications of Intercavernous Sinuses during Transsphenoidal Surgery: An Anatomical Analysis Based on Autopsy and Magnetic Resonance Venography

Abstract

PurposeVascular complications induced by intercavernous sinus injury during dural opening in the transsphenoidal surgery may contribute to incomplete tumour resections. Preoperative neuro-imaging is of crucial importance in planning surgical approach. The aim of this study is to correlate the microanatomy of intercavernous sinuses with its contrast-enhanced magnetic resonance venography (CE-MRV).MethodsEighteen human adult cadavers and 24 patients were examined based on autopsy and CE-MRV. Through dissection of the cadavers and CE-MRV, the location, shape, number, diameter and type of intercavernous sinuses were measured and compared.ResultsDifferent intercavernous sinuses were identified by their location and shape in all the cadavers and CE-MRV. Compared to the cadavers, CE-MRV revealed 37% of the anterior intercavernous sinus, 48% of the inferior intercavernous sinus, 30% of the posterior intercavernous sinus, 30% of the dorsum sellae sinus and 100% of the basilar sinus. The smaller intercavernous sinuses were not seen in the neuro-images. According to the presence of the anterior and inferior intercavernous sinus, four types of the intercavernous sinuses were identified in cadavers and CE-MRV, and the corresponding operative space in the transsphenoidal surgical approach was implemented.ConclusionThe morphology and classification of the cavernous sinus can be identified by CE-MRV, especially for the larger vessels, which cause bleeding more easily. Therefore, CE-MRV provides a reliable measure for individualized preoperative planning during transsphenoidal surgery.

An Anatomic Assessment of the Intercavernous Sinuses and Review of the Literature

“…Similar to our study, others have reported variability in the presence of the sinuses, with the anterior being the most consistent of all (Table 2). [1][2][3][4]7,[9][10][11] Ridley is credited with the first description of the intercavernous sinuses in 1695, referring to them as the "circular sinus" given their configuration around the infundibulum 3,12 . In 1763, Winslow additionally recognized the inferior intercavernous sinus, which he termed the "inferior circular sinus."…”

“…1,11 It is found within the dura of the clivus, is generally multiloculated, and additionally communicates with the superior and inferior petrosal sinuses. 1 Some authors refer to a fifth "dorsum sellae sinus", which is a widened venous channel on the posterior aspect of the dorsum sellae, 9,20 but this nomenclature is inconsistent and others consider this to be part of the basilar sinus.…”

“…Using data from 18 cadavers as a reference, MRV was able to detect 37% of AISs, 48% of IISs, 30% of PISs, 30% of DSSs, and 100% of BSs. 9 This low detection rate suggests that imaging alone is insufficient to determine the presence of these anatomical structures, and smaller sinuses may be difficult to detect without histology. The surgeon, therefore, must have an understanding of the anatomy without reliance on preoperative imaging to define the intercavernous sinuses.…”

Comparision between Nonvisualized Finding of 3D-Tof Mrv Cerebral and Cerebral Angiography Result

“…MRV test results showed 13 samples of nonvisualized, from those 13 samples the angiography obtained 12 samples (92.3%) of thrombus, while the remaining sample was normal. Findings nonvisualized on MRV showed 92.3% of thrombus on its angiography cerebral could be due to the 3D-TOF flow gap occurs as a result of intravascular slow blood flow as blood flow patterns are complex and varied features 14 . This diversity illustrates the pathophysiological changes seen after venous occlusion.…”

Safety window for the transsphenoidal approach for pituitary tumours: a computed tomographic angiography study

“…It is a challenging procedure due to the complexity of the anatomical region and the limited surgical area [1,5]. Common complications include intercavernous sinus bleeding and internal carotid artery (ICA) laceration [6,9,13]. Part of the ICA is located inside the cavernous venous sinus until it passes through the dura mater that forms the roof of the venous sinus [7,28].…”