Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Neurosurgery. 2010 Dec;67(2 Suppl Operative):391-4. doi: 10.1227/NEU.0b013e3181f74269.
During endoscopic transsphenoidal pituitary surgery, identification and constant awareness of the midline is imperative to prevent injury to critical lateral structures, such as the internal carotid arteries.
To describe the relevance of a midline filum of the sellar dura which, when present, can serve as a useful intraoperative anatomic marker.
Intraoperative video recordings of twenty patients undergoing endoscopic transsphenoidal surgery were retrospectively reviewed to assess for the presence and location of a midline dural filum or apparent central dural vascular structure. Prospective intraoperative data were gathered on an additional 16 patients.
A midline dural filum was identified in 18 of 36 patients (50%) undergoing endoscopic transsphenoidal surgery. This structure was identified on the midline in all cases, as confirmed by intraoperative neuronavigation and comparison with the vomer. The midline dural filum was identified as a strand-like dural extension (13 patients) or as a small vascular dural structure usually exhibiting low pressure venous bleeding (5 patients). Samples of the midline dural filum were obtained from 2 patients for histopathological analysis, which demonstrated dense collagenous connective tissue without evidence of vessel wall or ductal epithelium.
In addition to anatomic structures such as the vomer and midline sphenoid sinus septations, a midline dural filum serves as a useful marker during the sellar phase of endoscopic transsphenoidal surgery. Along with intraoperative neuronavigation and Doppler ultrasonography of the cavernous carotid arteries, identification of this structure may further aid in safeguarding against injury to critical paramedian structures.
在经鼻内镜垂体手术中，识别并始终保持正中位置对于防止损伤关键的外侧结构（如颈内动脉）至关重要。
描述鞍隔硬脑膜中线索的相关性，当存在时，它可以作为术中有用的解剖标志。
回顾性分析 20 例接受经鼻内镜垂体手术的患者的术中录像，评估中线硬脑膜索或明显的中央硬脑膜血管结构的存在和位置。前瞻性收集了另外 16 例患者的术中数据。
在接受经鼻内镜垂体手术的 36 例患者中，有 18 例（50%）发现中线硬脑膜索。该结构在所有病例中均位于中线，通过术中神经导航和与犁骨的比较得到证实。中线硬脑膜索被识别为索状硬脑膜延伸（13 例）或小的血管性硬脑膜结构，通常表现为低压静脉出血（5 例）。从 2 例患者中获取了中线硬脑膜索的样本进行组织病理学分析，结果显示为密集的胶原结缔组织，无血管壁或导管上皮的证据。
除了犁骨和正中蝶窦间隔等解剖结构外，中线硬脑膜索在经鼻内镜垂体手术的鞍区阶段也是一个有用的标志。结合术中神经导航和海绵窦颈动脉多普勒超声检查，识别该结构可能有助于进一步防止损伤关键的正中旁结构。
