DOI QR코드

DOI QR Code

Characterization of the Anatomic Location of the Pituitary Stalk and Its Relationship to the Dorsum Sellae, Tuberculum Sellae and Chiasmatic Cistern

  • Gulsen, Salih (Department of Neurosurgery, Faculty of Medicine, Baskent University) ;
  • Dinc, Ahmet Hakan (State Institute of Forensic Medicine, Ministry of Justice, Morque Department) ;
  • Unal, Melih (State Institute of Forensic Medicine, Ministry of Justice, Morque Department) ;
  • Canturk, Nergis (State Institute of Forensic Medicine, Ministry of Justice, Morque Department) ;
  • Altinors, Nur (Department of Neurosurgery, Faculty of Medicine, Baskent University)
  • 투고 : 2008.11.03
  • 심사 : 2009.01.27
  • 발행 : 2010.03.28

초록

Objective : The normal anatomic relationships characteristic of the pituitary stalk area were previously thought to involve only one location. The purpose of this study was to re-evaluate the anatomic location of the pituitary stalk and possible varying locations in relation to the tuberculum sellae and dorsum sellae using morphometric evaluation and anatomic dissection of human cadaveric specimens. The surgical implications of the variations are discussed. Methods : The calvaria were removed via routine autopsy dissections, and the brains were removed from the skull while preserving the pituitary stalk. The diaphragma sellae, tuberculum sellae, and the location of the pituitary stalk were examined in 60 human cadaveric heads obtained from fresh adult cadavers. Empty sellae were excluded. Results : The openings of the diaphragma sellae averaged $6.62{\pm}1.606mm$ (range, 3-9 mm). The distance between the tuberculum sellae and the posterior part of the pituitary stalk was 1 to 8 mm. The upper face of the diaphragma sellae appeared flat in 26 (43%), concave in 24 (40%), and convex in 6 cases (10%), with a prominent tuberculum sellae in 4 cases (7%). The location of the chiasm was normal in 47 cases (78%), with a prefixed chiasm in 3 cases (5%) and a postfixed chiasm (17%) in the 10 cases. Four cadaver specimens had prominent tuberculum sellae and other parameters were not evaluated. Conclusion : When opening the chiasmatic cistern, neurosurgeons should be aware about the relationship between the pituitary stalk and the surrounding structures to prevent inadvertent injury to the pituitary stalk.

키워드

참고문헌

  1. Ahmadi H, Larsson EM, Jinkins JR : Normal pituitary gland : coronal MR imaging of infundibular tilt. Radiology 177 : 389-392, 1990
  2. Amar AP, Weiss MH : Pituitary anatomy and physiology. Neurosurg Clin N Am 14 : 11-23, 2003 https://doi.org/10.1016/S1042-3680(02)00017-7
  3. Campero A, Martins C, Yasuda A, Rhoton AL Jr : Microsurgical anatomy of the diaphragma sellae and its role in directing the pattern of growth of pituitary adenomas. Neurosurgery 62 : 717-723; discussion 717-723, 2008 https://doi.org/10.1227/01.neu.0000317321.79106.37
  4. Carmel PW : Surgical syndromes of the hypothalamus. Clin Neurosurg 27 : 133-159, 1980 https://doi.org/10.1093/neurosurgery/27.CN_suppl_1.133
  5. Carmel PW, Antunes JL, Ferin M : Collection of blood from the pituitary stalk and portal veins in monkeys, and from the pituitary sinusoidal system of monkey and man. J Neurosurg 50 : 75-80, 1979 https://doi.org/10.3171/jns.1979.50.1.0075
  6. Castillo M : Pituitary gland : development, normal appearances, and magnetic resonance imaging protocols. Top Magn Reson Imaging 16 : 259-268, 2005 https://doi.org/10.1097/01.rmr.0000224682.91253.15
  7. Ciric I, Ragin A, Baumgartner C, Pierce D : Complications of trans-sphenoidal surgery : results of a national survey, review of the literature, and personal experience. Neurosurgery 40 : 225-236; discussion 236; 236-237, 1997 https://doi.org/10.1097/00006123-199702000-00001
  8. DeVile CJ, Grant DB, Hayward RD, Stanhope R : Growth and endocrine sequelae of craniopharyngioma. Arch Dis Child 75 : 108-114, 1996 https://doi.org/10.1136/adc.75.2.108
  9. Elster AD : Modern imaging of the pituitary. Radiology 187 : 1-14, 1993 https://doi.org/10.1148/radiology.187.1.8451394
  10. Lawrence H : Gray's Anatomy, ed 38. New York : ELBS & Churchill Livingstone, 1995, pp1882-1883
  11. Honegger J, Buchfelder M, Fahlbusch R : Surgical treatment of craniopharyngiomas : endocrinological results. J Neurosurg 90 : 251-257, 1999 https://doi.org/10.3171/jns.1999.90.2.0251
  12. Rhoton AL Jr : Tentorial incisura. Neurosurgery 47 : S131-S153, 2000 https://doi.org/10.1097/00006123-200009001-00015
  13. Rhoton AL Jr : The sellar region. Neurosurgery 51 : S335-S374, 2002 https://doi.org/10.1227/00006123-200208000-00007
  14. Yaşargil MG, Curcic M, Kis M, Siegenthaler G, Teddy PJ, Roth P : Total removal of craniopharyngiomas. Approaches and long-term results in 144 patients. J Neurosurg 73 : 3-11, 1990 https://doi.org/10.3171/jns.1990.73.1.0003
  15. Zhou ZQ, Shi XE : Changes of hypothalamus-pituitary hormones in patients after total removal of craniopharyngiomas. Chin Med J (Engl) 117 : 357-360, 2004

피인용 문헌

  1. Pituitary stalk duplication in ventral‐dorsal direction in a patient with pituitary gland adenoma and aqueductal stenosis vol.23, pp.8, 2010, https://doi.org/10.1002/ca.21030
  2. New Landmark for the Endoscopic Endonasal Transsphenoidal Approach of Pituitary Surgery vol.53, pp.4, 2010, https://doi.org/10.3340/jkns.2013.53.4.218
  3. Endoscopic distinction between capsule and pseudocapsule of pituitary adenomas vol.155, pp.9, 2010, https://doi.org/10.1007/s00701-013-1754-5
  4. Anatomical Analysis on the Lateral Bone Window of the Sella Turcica: A Study on 530 Adult Dry Skull Base Specimens vol.11, pp.2, 2010, https://doi.org/10.7150/ijms.7137
  5. Topographic variations of the optic chiasm and the pituitary stalk: a morphometric study based on midsagittal T2-weighted MR images vol.36, pp.8, 2010, https://doi.org/10.1007/s00276-014-1265-y
  6. Magnetic resonance imaging of optic nerve vol.25, pp.4, 2010, https://doi.org/10.4103/0971-3026.169462
  7. Comprehensive review on rhino-neurosurgery vol.14, pp.None, 2015, https://doi.org/10.3205/cto000116
  8. Can the angle between optic nerves indicate whether optic chiasm is prefixed, normofixed or postfixed? An anatomical study with radiologic and neurosurgical implications vol.38, pp.10, 2010, https://doi.org/10.1007/s00276-016-1676-z
  9. Interoptic, Trans-lamina Terminalis, Opticocarotid Triangle, and Caroticosylvian Windows From Mini-Supraorbital, Frontomedial, and Pterional Perspectives: A Comparative Cadaver Study With Artificial L vol.6, pp.None, 2019, https://doi.org/10.3389/fsurg.2019.00040
  10. Three-dimensional magnetic resonance-based morphometry of pituitary stalk vol.124, pp.3, 2010, https://doi.org/10.1007/s11547-018-0956-6
  11. Three-dimensional magnetic resonance-based morphometry of pituitary stalk vol.124, pp.3, 2010, https://doi.org/10.1007/s11547-018-0956-6
  12. The diaphragma sellae, diaphragm opening, and subdiaphragmatic cistern: an anatomical study using magnetic resonance imaging vol.41, pp.5, 2010, https://doi.org/10.1007/s00276-019-02184-0
  13. Development of a contouring guide for three different types of optic chiasm: A practical approach vol.63, pp.5, 2010, https://doi.org/10.1111/1754-9485.12903