Microsurgical anatomy of the inferior intercavernous sinus
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ORIGINAL ARTICLE
Microsurgical anatomy of the inferior intercavernous sinus Louis Chenin1,2 · Patrick Toussaint2 · Michel Lefranc2 · Eric Havet1 · Johann Peltier1,2 Received: 15 June 2020 / Accepted: 15 September 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Purpose Intercavernous sinuses (ICSs) are physiological communications between the cavernous sinuses. The ICSs run between the endosteal and meningeal layers of the dura mater of the sella turcica. Whereas the anterior and posterior ICSs have been frequently described, the inferior ICS (iICS) has been less well studied in the literature; however, poor awareness of the ICS’s anatomy can lead to serious problems during transsphenoidal, transsellar surgery. The objective of the present anatomical study was to describe the iICS in detail. Methods The study was carried out over a 6-month period in a university hospital’s anatomy laboratory, using brains extracted from human cadavers. The brains were injected with colored neoprene latex and dissected to study the iICS (presence or absence, shape, diameter, length, distance between inferior and anterior ICSs, distance between inferior and posterior ICSs, relationships, and boundaries). Results Seventeen cadaveric specimens were studied, and an iICS was found in all cases (100%). The shape was variously plexiform (47.1%), filiform (35.3%), or punctiform (17.6%). The mean ± standard deviation diameter and length of the iICS were 3.75 ± 2.90 mm and 11.92 ± 2.96 mm, respectively. The mean iICS-anterior ICS and iICS-posterior ICS distances were 5.36 ± 1.99 mm and 7.03 ± 2.28 mm, respectively. Conclusion The iICS has been poorly described in the literature. However, damage to the iICS during transsphenoidal, transsellar surgery could lead to serious vascular complications. A precise radiological assessment appears to be essential for a safe surgical approach. Keywords Inferior intercavernous sinus · Sella turcica · Pituitary gland · Pituitary adenoma · Transsphenoidal surgery
Introduction In humans, intercavernous sinuses (ICSs) are physiological transversal communications between the right and left cavernous sinuses at the base of the skull. Intercavernous sinuses have been described or mentioned in many anatomical [2, 5, 6, 8–10, 17, 18] or radiological studies [1, 3–5, 7, 14] since 1975. These venous channels vary in size and run between the endosteal and meningeal layers of the sella turcica’s dura mater [6, 8]. Initially, ICSs were referred to as
* Louis Chenin chenin.louis@chu‑amiens.fr 1
Department of Anatomy and Organogenesis, Faculty of Medicine, Jules Verne University of Picardie, 80000 Amiens, France
Department of Neurosurgery, Amiens University Hospital, 80000 Amiens, France
2
“coronary” or “circular” sinuses [6, 10, 18] because of their circular route around the pituitary gland. Many ICSs have been described in the literature, including three in the sella turcica. The best known are the anterior ICS (aICS, typically located at the anterior, superior edge of the pitu
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