Wu Xiao, Xie Shen Hao, Tang Bin, Yang You Qing, Yang Le, Ding Han, Bao You Yuan, Lan Shi Hai, Zhou Lin, Hong Tao
Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, China.
Neurosurg Rev. 2021 Aug;44(4):2229-2237. doi: 10.1007/s10143-020-01404-1. Epub 2020 Oct 2.
We found a series of Knosp grade 3A-4 pituitary adenomas in the posterior areas of the cavernous sinus (CS), a triangular-like structure on axial MRI. In this study, we dissected the surrounding neurovascular structure, discussed the surgical approach, and analyzed outcomes for patients with this invasion into this area. Eight embalmed adult cadaveric specimens were prepared for this study to demonstrate in detail the surgical anatomy related to this triangular-like structure. We used the "two points and one line" method to determine the surgical approach, and 35 cases with this area invasion were retrospectively reviewed. According to the endoscopic and microsurgical anatomy, the triangular-like structure appearing on the axial MRI is correlated with a square-based pyramid structure in the CS, and the upper surface is the posterior portion of the oculomotor triangle. A total of 37 posterior areas of the CS were involved in 35 patients. The accuracy of the "two points and one line" method in predicting the surgical approach is 86.5% (32/37). All three patients with Knosp 3A underwent gross total resection (GTR). Twenty (62.5%) patients with Knosp 4 underwent GTR, 9 (28.1%) patients underwent subtotal resection, and 3 (9.4%) patients underwent partial resection. Preoperative symptoms were alleviated to varying degrees, and no worsening occurred. Postoperative complications included two (5.7%) cases of cerebrospinal fluid leakage, one (2.9%) case of meningitis, two (5.7%) cases of permanent diabetes insipidus, and three (8.6%) cases of transient cranial nerve palsy. The "two points and one line" method is of great value in predicting the surgical approach of pituitary adenomas with CS invasion. The anatomic description of this particular square-based pyramid structure in the CS refines the understanding of pituitary adenomas with CS invasion.
我们在海绵窦（CS）后部区域发现了一系列Knosp 3A - 4级垂体腺瘤，在轴向磁共振成像（MRI）上呈三角形结构。在本研究中，我们解剖了周围的神经血管结构，讨论了手术入路，并分析了侵入该区域患者的手术结果。为此研究准备了8具经过防腐处理的成人尸体标本，以详细展示与该三角形结构相关的手术解剖结构。我们采用“两点一线”法确定手术入路，并对35例该区域侵犯的病例进行了回顾性分析。根据内镜和显微手术解剖学，轴向MRI上出现的三角形结构与CS中的方底金字塔结构相关，其上表面是动眼神经三角的后部。35例患者共累及37个CS后部区域。“两点一线”法预测手术入路的准确率为86.5%（32/37）。所有3例Knosp 3A患者均实现了全切除（GTR）。20例（62.5%）Knosp 4患者实现了GTR，9例（28.1%）患者接受了次全切除，3例（9.4%）患者接受了部分切除。术前症状得到不同程度缓解，且未出现恶化。术后并发症包括2例（5.7%）脑脊液漏、1例（2.9%）脑膜炎、2例（5.7%）永久性尿崩症和3例（8.6%）短暂性颅神经麻痹。“两点一线”法在预测侵犯CS的垂体腺瘤手术入路方面具有重要价值。对CS中这种特殊方底金字塔结构的解剖学描述加深了对侵犯CS的垂体腺瘤的理解。
