Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
Department of Neurosurgery, Stanford Hospital, Stanford, California, USA.
Oper Neurosurg. 2022 Aug 1;23(2):115-124. doi: 10.1227/ons.0000000000000291. Epub 2022 Jun 10.
Pituitary adenomas (PAs) with cavernous sinus (CS) invasion can extend into the intradural space by breaking through the CS walls.
To elaborate on the potential breakthrough route through CS compartments for invasive PAs and describe relevant surgical anatomy and technical nuances, with an aim to improve resection rates.
Twelve colored silicon-injected human head specimens were used for endonasal and transcranial dissection of the CS walls; ligaments, dural folds, and cranial nerves on each compartment were inspected. Two illustrative cases of invasive PA are also presented.
The potential breakthrough routes through the CS compartments had unique anatomic features. The superior compartment breakthrough was delimited by the anterior petroclinoidal ligament laterally, posterior petroclinoidal ligament posteriorly, and interclinoidal ligament medially; tumor extended into the parapeduncular space with an intimate spatial relationship with the oculomotor nerve and posterior communicating artery. The lateral compartment breakthrough was limited by the anterior petroclinoidal ligament superiorly and ophthalmic nerve inferiorly; tumor extended into the middle fossa, displacing the trochlear nerve and inferolateral trunk to reach the medial temporal lobe. The posterior compartment breakthrough delineated by the Gruber ligament, petrosal process of the sphenoid bone, and petrous apex inferiorly, posterior petroclinoidal ligament superiorly, and dorsum sellae medially; tumor displaced or encased the abducens nerve and inferior hypophyseal artery and compressed the cerebral peduncle.
The superior lateral and posterior components of the CS are potential routes for invasion by PAs. Better identification of CS breakthrough patterns is crucial for achieving higher gross total resection and remission rates.
海绵窦（CS）侵袭性垂体腺瘤（PA）可通过突破 CS 壁向颅内扩展。
详细阐述侵袭性 PA 通过 CS 间隙潜在的突破途径，并描述相关的手术解剖和技术要点，以提高切除率。
使用 12 个人头标本进行经鼻和经颅 CS 壁解剖；检查每个间隙的韧带、硬脑膜褶皱和颅神经。还呈现了 2 个侵袭性 PA 的病例。
CS 间隙的潜在突破途径具有独特的解剖特征。上间隙突破由外侧的前岩下裂带、后侧的后岩下裂带和内侧的交叉内韧带限制；肿瘤向鞍旁间隙扩展，与动眼神经和后交通动脉关系密切。外侧间隙突破由上方的前岩下裂带和下方的视神经限制；肿瘤向中颅窝扩展，推移滑车神经和下外侧干到达颞内侧叶。由 Gruber 韧带、蝶骨岩部和岩尖下方、上方的后岩下裂带和内侧的鞍背限制的后间隙突破；肿瘤推移或包裹展神经和垂体下动脉，并压迫脑脚。
CS 的上外侧和后部分是 PA 侵袭的潜在途径。更好地识别 CS 突破模式对于实现更高的大体全切除率和缓解率至关重要。
