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BACKGROUND: The sphenoid wing dural arteriovenous fistula (AVF) is rare, and can manifest with severe symptoms, particularly in cases classified as greater sphenoid wing type. Endovascular therapy is generally employed, however, open surgical intervention could be warranted in cases with complex fistula. METHOD: We present a case with ruptured greater sphenoid wing dural AVF (Cognard type IV), in which endovascular embolization using liquid material was performed, followed by open surgery to concurrently disconnect the fistula and evacuate the hematoma. CONCLUSION: The sphenoid wing dural AVFs may be effectively cured by open surgery for fistula disconnection in conjunction with endovascular embolization.
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Malformaciones Vasculares del Sistema Nervioso Central , Embolización Terapéutica , Humanos , Malformaciones Vasculares del Sistema Nervioso Central/cirugía , Malformaciones Vasculares del Sistema Nervioso Central/diagnóstico por imagen , Malformaciones Vasculares del Sistema Nervioso Central/terapia , Embolización Terapéutica/métodos , Masculino , Procedimientos Endovasculares/métodos , Hueso Esfenoides/cirugía , Hueso Esfenoides/diagnóstico por imagen , Resultado del Tratamiento , Persona de Mediana Edad , Femenino , Angiografía CerebralRESUMEN
BACKGROUND AND IMPORTANCE: Spheno-orbital meningiomas (SOMs) pose a challenge to the skull base neurosurgeon because of their variable presentation and involvement of critical structures within the orbit. There is no consensus on optimal management of these patients and how to achieve maximal safe resection. The authors share an illustrative case with an accompanying video to demonstrate their aggressive approach to resect SOMs and their intraorbital components. CLINICAL PRESENTATION: A 75-year-old-woman presented with progressive vision loss and proptosis. Magnetic resonance imaging was consistent with a large, left-sided sphenoid wing meningioma with extension to the orbital wall and compression of the optic nerve medially. The patient elected to undergo surgical excision and optic nerve decompression. She did well postoperatively with resolution of proptosis and good resection margins on follow-up imaging. CONCLUSION: Aggressive resection of SOMs is possible with an understanding of the underlying anatomy. Familiarity with the orbit can facilitate a maximal safe resection with optic nerve decompression.
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Neoplasias Meníngeas , Meningioma , Procedimientos Neuroquirúrgicos , Neoplasias Orbitales , Humanos , Meningioma/cirugía , Meningioma/diagnóstico por imagen , Femenino , Anciano , Neoplasias Meníngeas/cirugía , Neoplasias Meníngeas/diagnóstico por imagen , Procedimientos Neuroquirúrgicos/métodos , Neoplasias Orbitales/cirugía , Neoplasias Orbitales/diagnóstico por imagen , Hueso Esfenoides/cirugía , Hueso Esfenoides/diagnóstico por imagen , Descompresión Quirúrgica/métodos , Órbita/cirugía , Órbita/diagnóstico por imagen , Imagen por Resonancia MagnéticaRESUMEN
Objective:To study the clinical anatomy of the sphenopalatine foramina by dissecting the sphenopalatine foramina during Vidian nerve branch neurotomy. The anatomy and CBCT images of sphenopalatine foramen were analyzed to facilitate the navigational of clinical operation using CBCT images. Methods:From October 2017 to September 2023, 84 casesï¼168 sidesï¼ of Vidian nerve branch neurotomy in our department were collected. The clinical summary was made according to the anatomy of sphenopalatine foramen during the operation. Preoperative CBCT imaging findings of the sphenopalatine foramina were also studied. Results:The clinical anatomy of sphenopalatine foramen could be divided into four types: middle meatus typeï¼1.19%ï¼, trans-meatus typeï¼62.29%ï¼, superior meatus typeï¼33.33%ï¼ and double foramen typeï¼1.19%ï¼. The incidence of ethmoidal ridge was 98.81%. The distance from sphenopalatine foramina to posterior nasal canal wereï¼14.63±2.66ï¼ mm to left andï¼14.65±2.63ï¼ mm to right, The position Angle â a of lower margin of sphenopalatine foramina wereï¼62.36±10.05ï¼° to left andï¼61.51±11.82ï¼° to right, respectively. Axial CT images can be used to divide the sphenopalatine foramen into five levels: the upper edge of the sphenopalatine foramen level, the Vidian nerve level, the basal plate interaction level, the lower edge of the sphenopalatine foramen level and the pterygopalatine canal level. The agreement between endoscopic anatomy of sphenopalatine foramen and imaging navigation was 100%. Conclusion:The sphenopalatine foramina exhibit various anatomical types. The preoperative navigational CBCT reading can effectively identify the type of sphenopalatine foramina, guide the choice of surgical method, and help avoid serious complications. This has significant clinical application value.
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Tomografía Computarizada de Haz Cónico , Endoscopía , Humanos , Tomografía Computarizada de Haz Cónico/métodos , Endoscopía/métodos , Masculino , Femenino , Persona de Mediana Edad , Hueso Esfenoides/diagnóstico por imagen , Hueso Esfenoides/anatomía & histología , Adulto , Cavidad Nasal/diagnóstico por imagen , Cavidad Nasal/anatomía & histologíaRESUMEN
Many studies revealed that the sphenoid sinus pneumatization (SSP) affects the protrusion/dehiscence of adjacent structures including optic canal (OC), foramen rotundum (FR), vidian canal (VC), and carotid canal (CC). Knowledge of this relationship bears vital importance to identify the safest surgical route during transsphenoidal procedures. Therefore, we aimed to determine the individualized prevalence of the protrusion/dehiscence of adjacent structures based on sagittal and coronal SSP (SSSP and CSSP) patterns. Computed tomography images of 300 patients were analysed to identify the SSSP and CSSP types, and the protrusion/dehiscence of adjacent structures was determined. The relationship between the variables was examined using statistical analysis in terms of age, gender, and laterality. The most prevalent SSSP type was postsellar (62.7%), followed by sellar (30%), presellar (6.6%), and conchal (0.7%). In 71.3% of patients, five types of CSSP were observed, with 23.6% and 21.7% exhibiting Type IV and V, respectively. Our results indicated that postsellar type, Type IV and V CSSP associated with the highest likelihood of protrusion/dehiscence of OC, FR, VC, and CC. Furthermore, no significant correlation was observed between these qualitative variables and gender, with the exception of the VC dehiscence, the protrusion of OC and CC. No notable differences were identified with respect to laterality. Also, the probability of having postsellar type, Type IV and V CSSP, as well as the protrusion of OC, VC, and CC, decreased with increasing age. Further detailed analysis of this association is required to predict the size of the surgical window and to prevent neurovascular injury.
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Seno Esfenoidal , Tomografía Computarizada por Rayos X , Humanos , Seno Esfenoidal/diagnóstico por imagen , Seno Esfenoidal/anatomía & histología , Masculino , Femenino , Persona de Mediana Edad , Adulto , Anciano , Adolescente , Adulto Joven , Factores de Edad , Anciano de 80 o más Años , Factores Sexuales , Hueso Esfenoides/diagnóstico por imagen , Caracteres SexualesRESUMEN
BACKGROUND AND PURPOSE: Morning glory disc anomaly (MGDA) is a congenital malformation characterized by a funnel-shaped optic disc excavation with radiating vessels and a central glial tuft. Imaging is essential to evaluate associated cephalocele and steno-occlusive vasculopathy. The goal of this study was to assess optic nerve, chiasmatic, and sphenoid bone morphology in MGDA. MATERIALS AND METHODS: This retrospective study examined all subjects with funduscopically confirmed MGDA diagnosed and imaged with brain MR imaging between 2008 and 2023. RESULTS: Thirty-two children met inclusion criteria. Ocular involvement was unilateral in 29 subjects and bilateral in 3. Segmental optic nerve enlargement ipsilateral to the MGDA was seen in 21 subjects, with 3 also demonstrating a segmental reduction in the size of the ipsilateral optic nerve. Segmental reduction in the size of the ipsilateral optic nerve was present in 3 additional subjects, one with bilateral MGDA. The optic chiasm appeared asymmetrically thickened in 21 subjects, often with deformity. The optic nerves appeared normal in signal intensity in all subjects, with faint peripheral chiasmatic enhancement in 4 of 20 patients who received contrast. Optic nerve findings were stable in 15 subjects with multiple examinations. A persistent craniopharyngeal canal was identified in 17 subjects with sphenoid cephalocele in 1 and mild inferior pituitary gland displacement in 4. Tubular or nodular nasopharyngeal lesions were seen in 10 subjects. One subject had an off-midline sphenoid bone cleft, midbrain deformity, and abnormal thickening of and enhancement around the left oculomotor nerve; the oculomotor nerve finding was present in 1 additional patient. CONCLUSIONS: MGDA often manifests with ipsilateral optic nerve thickening, leading to a potential misdiagnosis as optic glioma. MGDA is also commonly associated with a persistent craniopharyngeal canal with variable pituitary gland and infundibular deformity, cephalocele, and tubular or nodular nasopharyngeal lesions.
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Imagen por Resonancia Magnética , Disco Óptico , Humanos , Femenino , Masculino , Estudios Retrospectivos , Niño , Imagen por Resonancia Magnética/métodos , Disco Óptico/diagnóstico por imagen , Disco Óptico/anomalías , Disco Óptico/patología , Preescolar , Adolescente , Lactante , Fenotipo , Hueso Esfenoides/diagnóstico por imagen , Hueso Esfenoides/anomalías , Hueso Esfenoides/patología , Quiasma Óptico/diagnóstico por imagen , Quiasma Óptico/anomalías , Quiasma Óptico/patología , Anomalías del Ojo/diagnóstico por imagen , Anomalías del Ojo/patologíaAsunto(s)
Neoplasias Meníngeas , Meningioma , Procedimientos Neuroquirúrgicos , Humanos , Meningioma/cirugía , Meningioma/diagnóstico por imagen , Neoplasias Meníngeas/cirugía , Neoplasias Meníngeas/diagnóstico por imagen , Procedimientos Neuroquirúrgicos/métodos , Procedimientos Neuroquirúrgicos/educación , Neoplasias Orbitales/cirugía , Neoplasias Orbitales/diagnóstico por imagen , Órbita/cirugía , Órbita/diagnóstico por imagen , Hueso Esfenoides/cirugía , Hueso Esfenoides/diagnóstico por imagen , Hueso Temporal/cirugía , Hueso Temporal/diagnóstico por imagenAsunto(s)
Neoplasias Meníngeas , Meningioma , Procedimientos Neuroquirúrgicos , Humanos , Meningioma/cirugía , Meningioma/diagnóstico por imagen , Neoplasias Meníngeas/cirugía , Neoplasias Meníngeas/diagnóstico por imagen , Procedimientos Neuroquirúrgicos/métodos , Procedimientos Neuroquirúrgicos/educación , Neoplasias Orbitales/cirugía , Neoplasias Orbitales/diagnóstico por imagen , Órbita/cirugía , Órbita/diagnóstico por imagen , Hueso Esfenoides/cirugía , Hueso Esfenoides/diagnóstico por imagen , Hueso Temporal/cirugía , Hueso Temporal/diagnóstico por imagenAsunto(s)
Neoplasias Meníngeas , Meningioma , Procedimientos Neuroquirúrgicos , Humanos , Meningioma/cirugía , Meningioma/diagnóstico por imagen , Neoplasias Meníngeas/cirugía , Neoplasias Meníngeas/diagnóstico por imagen , Procedimientos Neuroquirúrgicos/métodos , Procedimientos Neuroquirúrgicos/educación , Neoplasias Orbitales/cirugía , Neoplasias Orbitales/diagnóstico por imagen , Órbita/cirugía , Órbita/diagnóstico por imagen , Hueso Esfenoides/cirugía , Hueso Esfenoides/diagnóstico por imagen , Hueso Temporal/cirugía , Hueso Temporal/diagnóstico por imagenAsunto(s)
Neoplasias Meníngeas , Meningioma , Humanos , Meningioma/diagnóstico por imagen , Meningioma/patología , Meningioma/cirugía , Neoplasias Meníngeas/diagnóstico por imagen , Neoplasias Meníngeas/patología , Pronóstico , Neoplasias Orbitales/diagnóstico por imagen , Neoplasias Orbitales/cirugía , Neoplasias Orbitales/patología , Hueso Esfenoides/diagnóstico por imagen , Hueso Esfenoides/cirugíaAsunto(s)
Neoplasias Meníngeas , Meningioma , Humanos , Meningioma/diagnóstico por imagen , Meningioma/patología , Meningioma/cirugía , Neoplasias Meníngeas/diagnóstico por imagen , Neoplasias Meníngeas/patología , Neoplasias Meníngeas/cirugía , Pronóstico , Neoplasias Orbitales/diagnóstico por imagen , Neoplasias Orbitales/cirugía , Neoplasias Orbitales/patología , Hueso Esfenoides/diagnóstico por imagen , Hueso Esfenoides/cirugíaRESUMEN
BACKGROUND: At times, a regulation internal carotid artery-posterior communicating artery junction (ICA-P-Comm) aneurysm becomes a surgical hurdle owing to its close proximity to the anterior clinoid process, an immovable ICA and a concealed dominant P-Comm artery arising from the aneurysm neck. METHOD: A 70 year old patient with a low lying ICA-P-Comm aneurysm underwent a "tailored" intradural clinoidectomy for aneurysm clipping. CONCLUSION: A tailored anterior clinoidectomy to expose "just enough" allows a proximal ICA control in a suitable area, mobility of an atherosclerotic ICA and exposes the P-Comm artery origin which are essential in safe clipping of these aneurysms.
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Arteria Carótida Interna , Aneurisma Intracraneal , Anciano , Humanos , Enfermedades de las Arterias Carótidas/cirugía , Arteria Carótida Interna/cirugía , Arteria Carótida Interna/diagnóstico por imagen , Aneurisma Intracraneal/cirugía , Aneurisma Intracraneal/diagnóstico por imagen , Procedimientos Neuroquirúrgicos/métodos , Hueso Esfenoides/cirugía , Hueso Esfenoides/diagnóstico por imagen , Resultado del TratamientoRESUMEN
The aim of the present study was to examine the growth dynamics of the two ossification centers of the body of sphenoid bone in the human fetus, based on their linear, planar and volumetric parameters. The examinations were carried out on 37 human fetuses of both sexes aged 18-30 weeks of gestation, which had been preserved in 10% neutral formalin solution. Using CT, digital image analysis software, 3D reconstruction and statistical methods, we evaluated the size of the presphenoid and postsphenoid ossification centers. The presphenoid ossification center grew proportionately in sagittal diameter, projection surface area and volume, and logarithmically in transverse diameter. The postsphenoid ossification center increased logarithmically in sagittal diameter, transverse diameter and projection surface area, while its volumetric growth followed proportionately. The numerical findings of the presphenoid and postsphenoid ossification centers may be considered age-specific reference values of potential relevance in monitoring the normal fetal growth and screening for congenital disorders in the fetus. The obtained results may contribute to a better understanding of the growing fetal skeleton, bringing new numerical information regarding its diagnosis and development.
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Feto , Osteogénesis , Hueso Esfenoides , Humanos , Hueso Esfenoides/diagnóstico por imagen , Hueso Esfenoides/embriología , Hueso Esfenoides/crecimiento & desarrollo , Femenino , Osteogénesis/fisiología , Masculino , Feto/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Desarrollo Fetal/fisiología , Imagenología Tridimensional , Edad GestacionalAsunto(s)
Neoplasias Meníngeas , Meningioma , Procedimientos Neuroquirúrgicos , Humanos , Meningioma/cirugía , Meningioma/diagnóstico por imagen , Neoplasias Meníngeas/cirugía , Neoplasias Meníngeas/diagnóstico por imagen , Procedimientos Neuroquirúrgicos/métodos , Procedimientos Neuroquirúrgicos/educación , Neoplasias Orbitales/cirugía , Neoplasias Orbitales/diagnóstico por imagen , Órbita/cirugía , Órbita/diagnóstico por imagen , Hueso Esfenoides/cirugía , Hueso Esfenoides/diagnóstico por imagen , Hueso Temporal/cirugía , Hueso Temporal/diagnóstico por imagenRESUMEN
PURPOSE: This examination aimed to display the size and topographic position of the Vidian canal (VC) in normal children. METHODS: 180 pediatric subjects aged 1-18 years were included this computed tomography examination. The distances of VC to certain landmarks, and VC length were measured. The locations of VC according to the sphenoid sinus, and the medial plate of pterygoid process were classified as three types, separately. RESULTS: The distances of VC to the vomerine crest, midsagittal plane, round foramen, and the superior wall of sphenoid sinus were measured as 12.68 ± 3.17 mm, 10.76 ± 2.52 mm, 8.62 ± 2.35 mm, and 14.16 ± 5.00 mm, respectively. The length and angle of VC were measured as 12.00 ± 2.52 mm, and 16.60 ± 9.76°, respectively. According to the sphenoid bone, VC location was identified as Type 1 in 113 sides (47.5%), as Type 2 in 70 sides (29.4%), and as Type 3 in 55 sides (23.1%). According to the medial plate of pterygoid process, VC location was identified as Type A in 274 sides (76.1%), as Type B in 55 sides (15.3%), and as Type C in 31 sides (8.6%). VC location types correlated with pediatric ages, but not sex or side. CONCLUSION: With advancing pediatric age, the protrusion of VC into the sphenoid sinus increases, and VC shifts from medial to lateral side of the medial plate of pterygoid process.
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Seno Esfenoidal , Tomografía Computarizada por Rayos X , Humanos , Niño , Masculino , Femenino , Adolescente , Preescolar , Lactante , Seno Esfenoidal/diagnóstico por imagen , Seno Esfenoidal/anatomía & histología , Hueso Esfenoides/diagnóstico por imagen , Hueso Esfenoides/anatomía & histología , Puntos Anatómicos de Referencia , Valores de ReferenciaRESUMEN
PURPOSE: Langerhans cell histiocytosis (LCH) is a rare condition arising from the monoclonal expansion of myeloid precursor cells, which results in granulomatous lesions that characteristically express CD1a/CD207. We report a case of LCH in a 3-year-old male involving the sphenoid bone with extension into the sellar/suprasellar region. CASE REPORT: A 3-year-old male presented with progressively worsening headaches and associated night sweats, neck stiffness, and fatigue over the previous 4 weeks. Magnetic resonance imaging (MRI) revealed a 2.4-cm lytic lesion within the basisphenoid, exerting mass effect upon the pituitary gland. A biopsy was performed to determine the etiology of the lesion. Postoperatively, the patient developed an intralesional hematoma with visual complications requiring emergent surgical resection via endoscopic endonasal approach. Final pathology confirmed LCH. The patient had improvement in his vision long term. CONCLUSIONS: LCH extending into the sella is a rare but important diagnosis to consider in pediatric patients presenting with lesions in this region. We presented a case of a pediatric patient presenting with LCH of the sphenoid bone extending into the sella, with subsequent apoplexy and vision loss. Review of the literature showed varying treatment options for these patients, including purely surgical and non-surgical treatments. Early intervention may be necessary to avoid potentially devastating neurologic sequelae.
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Histiocitosis de Células de Langerhans , Imagen por Resonancia Magnética , Humanos , Histiocitosis de Células de Langerhans/complicaciones , Histiocitosis de Células de Langerhans/cirugía , Histiocitosis de Células de Langerhans/diagnóstico por imagen , Histiocitosis de Células de Langerhans/patología , Masculino , Preescolar , Silla Turca/diagnóstico por imagen , Silla Turca/patología , Silla Turca/cirugía , Hueso Esfenoides/cirugía , Hueso Esfenoides/diagnóstico por imagen , Hueso Esfenoides/patologíaRESUMEN
BACKGROUND: In human anatomy, there are well-known the foramina of the greater sphenoidal wing, the foramen rotundum, the foramen ovale, the foramen spinosum, as well as the inconstant sphenoidal emissary foramen of Vesalius and the foramen of Arnold. Different canals are found in several species of rodents, such as the alisphenoid and sphenopterygoid (SPC) canals. METHOD: It was re-explored an archived computed tomography angiogram of a 60 y.o. female case. RESULTS: Bilateral superior recesses of the pterygoid fossae (SRPF) and a right SPC were found. The SRPF on each side penetrated the non-lamellar pterygoid root and superiorly reached the sphenoidal sinus wall. Upper fibres of medial pterygoid muscles were inserted into each SRPF. An unexpected SPC was found on the right side. It opened superiorly on the lateral side of the foramen rotundum and inferiorly at a pterygoid foramen in the superior end of the posterior margin of the lateral pterygoid plate. A sphenoidal emissary vein traversed that SPC to drain into the pterygoid plexus. CONCLUSION: The SRPF and SPC could also be found in humans. As the sphenoidal emissary veins are surgically relevant, they should not be further regarded as exclusively crossing the foramen of Vesalius but also the SPC.
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Hueso Esfenoides , Humanos , Femenino , Hueso Esfenoides/diagnóstico por imagen , Hueso Esfenoides/anatomía & histología , Angiografía por Tomografía Computarizada , Seno Esfenoidal/anatomía & histología , Seno Esfenoidal/diagnóstico por imagen , Persona de Mediana Edad , Músculos Pterigoideos/anatomía & histología , Músculos Pterigoideos/diagnóstico por imagen , Variación AnatómicaRESUMEN
PURPOSE: To describe the relation of the sphenoid ridge (SR) with the surrounding anatomical structures in healthy children when approaching the anterior and middle fossae. METHODS: Computed tomography of 180 pediatric patients (90 males / 90 females), aged 1-18 years were included the study. The size of the lesser wing (LW) and the distances of the LW to certain landmarks were measured. RESULTS: The LW length was 28.48 ± 8.15 mm. The LW widths at the midline and the midpoint and lateral point of the SR were 7.78 ± 1.74 mm, 2.84 ± 0.81 mm, and 1.91 ± 0.64 mm, respectively. The distance between the midpoint of the SR and the crista galli was 28.22 ± 5.56 mm, and the distance between the crista alaris and internal auditory meatus was 51.73 ± 5.79 mm. The linear function was calculated as y = 18.748 + 1.024 × age for SR length, y = 6.046 + 0.182 × age for the midline width of SR, y = 2.367 + 0.050 × age for the midpoint width of SR, y = 1.249 + 0.069 × age for the crista alaris width, y = 21.727 + 0.683 × age for the distance between the SR midpoint and the crista galli, and y = 43.614 + 0.855 × age for the distance between the crista alaris and internal auditory meatus. CONCLUSION: All measured parameters increased irregularly with advancing age. Furthermore, our regression equations representing the growth dynamics of SR may be used to estimate these parameters.
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Hueso Esfenoides , Tomografía Computarizada por Rayos X , Humanos , Masculino , Femenino , Niño , Adolescente , Hueso Esfenoides/anatomía & histología , Hueso Esfenoides/diagnóstico por imagen , Preescolar , LactanteRESUMEN
A mixed germ cell tumor (MGCT) in the neurohypophysis is very rare, with only a few reported cases1-4 but none with surgical videos. In this report, the endoscopic endonasal transsphenoidal approach for MGCT in the neurohypophysis is presented (Video 1). A 12-year-old girl with ocular pain, fatigue, and nausea presented with gradual onset of quadrant hemianopsia and left oculomotor palsy. Magnetic resonance imaging showed an enhanced mass in the sella turcica with multiple components involving the pituitary gland and stalk. Her endocrinological examination showed decreased levels of pituitary hormones and simultaneously elevated serum levels of alpha-fetoprotein and beta-human chorionic gonadotropin. After pituitary hormone replacement, endoscopic endonasal transsphenoidal surgery was planned. The tumor was strongly adherent to the surrounding structures, and gross total resection was achieved. The histological diagnosis was MGCT with a teratoma component. Postoperatively, her vision and oculomotor palsy improved swiftly, and adjuvant chemotherapy and radiotherapy were administered. In this case, 3-dimensional computer graphics were created from the preoperative computed tomography and magnetic resonance imaging studies. Preoperative simulation with the 3-dimensional computer graphic images and intraoperative verification with indocyanine green images facilitated our understanding of the surrounding anatomy, including the tumor components, pituitary gland, and internal carotid arteries.5 After removal of the tumor, multilayer fascial closure was performed for skull base reconstruction.6 MGCT in the neurohypophysis can be strongly adherent to the surrounding structures, requiring careful dissection and resection under endoscopy. At the last follow-up (8 months after surgery), the tumor was successfully controlled, and the patient had no neurological symptoms with pituitary hormone replacement therapy.