Surgical anatomy and nuances of the expanded endonasal transdorsum sellae and posterior clinoidectomy approach to the in
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HOW I DO IT - NEUROSURGICAL ANATOMY
Surgical anatomy and nuances of the expanded endonasal transdorsum sellae and posterior clinoidectomy approach to the interpeduncular and prepontine cisterns: a stepwise cadaveric dissection of various pituitary gland transpositions Thaïs Cristina Rejane-Heim 1,2,3,4 & Giuliano Silveira-Bertazzo 1 & Ricardo L. Carrau 1,5 & Daniel M. Prevedello 1,5 Received: 19 April 2020 / Accepted: 16 September 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background Excelsior knowledge of endoscopic anatomy and techniques to remove the natural barriers preventing full endonasal access to the interpeduncular and prepontine cisterns determines the ease of transposing the pituitary gland (hypophysiopexy) preserving the glandular function without manipulating the optic apparatus and the oculomotor nerves. Methods Throughout stepwise cadaveric dissections, we describe the expanded endonasal approach (EEA) to the interpeduncular and prepontine cisterns with special references to the intricate anatomy of the region and techniques for hypophysiopexy and posterior clinoidectomies. Conclusion This article illustrates sellar-diaphragmatic dural incisions and various “pituitary gland transpositions” techniques performed via extradural (lifting the gland still covered by both dural layers), interdural (transcavernous), and intradural (between the medial wall of the cavernous sinus and the pituitary tunica) to access the prepontine and interpeduncular cisterns. Keywords Skull base surgery . EEA . Posterior clinoidectomies . Endonasal . Endoscopic . Transdorsum approach . Endoscopic posterior clinoidectomy . Pituitary transposition . Hypophysiopexy . Interpeduncular cistern . Parapeduncular space . Interclinoid . Caroticoclinoid ligament . Transcavernous . Hemitransposition
Abbreviations EEA Expanded endoscopic endonasal approaches ICA Internal carotid artery IGS Image guidance system PCPs Posterior clinoid processes SSEP Somato-sensory evoked potential
SICS PG IHA DS MWCS
Superior intercavernous sinus Pituitary gland Inferior hypophyseal artery Dorsum sellae Medial wall of the cavernous sinus
This article is part of the Topical Collection on Neurosurgical Anatomy Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00701-020-04590-5) contains supplementary material, which is available to authorized users. * Daniel M. Prevedello [email protected] 1
Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, OH, USA
2
Department of Pediatric Endocrinology, Nationwide Children’s Hospital, Columbus, OH, USA
3
Department of Pediatric Endocrinology, Federal University of Santa Catarina, Florianópolis, SC, Brazil
4
Department of Pediatric Neuroendocrinology and Pediatric Endocrinology, Jeser Amarante Faria Children’s Hospital, and Neurological and Neurosurgical Clinic of Joinville, Joinville, SC, Brazil
5
Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Medical Center, C
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