The "candy wrapper" of the pituitary gland: a road map to the parasellar ligaments and the medial wall of the cavernous sinus.

PURPOSE: The anatomy of the medial wall of the cavernous sinus (MWCS) and parasellar ligaments (PLs) has acquired increasing importance in endoscopic endonasal (EE) surgery of the cavernous sinus (CS), including resection of the MWCS in functioning pituitary adenomas (FPAs). Although anatomical studies have been published, it represents a debated topic due to their complex morphology. The aim is to offer a description of the PLs that originate from the MWCS and reach the lateral wall of the cavernous sinus (LWCS), proposing the "candy wrapper" model. The relationships between the neurovascular structures and histomorphological aspects were investigated. METHODS: Forty-two CSs from twenty-one human heads were studied. Eleven specimens were used for EE dissection; five underwent a microscopic dissection. Five specimens were used for histomorphological analysis. RESULTS: Two groups of PLs with a fan-shaped appearance were encountered. The anterior group included the periosteal ligament (55% sides) and the carotico-clinoid complex (100% sides), formed by the anterior horizontal and the carotico-clinoid ligaments. The posterior group was formed by the posterior horizontal (78% sides), and the inferior hypophyseal ligament (34% sides). The periosteal ligament originated inferiorly from the MWCS, reaching the periosteal dura. The anterior horizontal ligament was divided in a superior and inferior branch. The superior one continued as the carotid-oculomotor membrane, and the inferior branch reached the CN VI. The carotico-clinoid ligament between the middle and anterior clinoid was ossified in 3 sides. The posterior horizontal ligament was related to the posterior genu and ended at the LWCS. The inferior hypophyseal ligament followed the homonym artery. The ligaments related to the ICA form part of the adventitia. CONCLUSION: The "candy wrapper" model adds further details to the previous descriptions of the PLs. Understanding this complex anatomy is essential for safe CS surgery, including MWCS resection for FPAs.

Endoscopic endonasal surgical anatomy through the prechiasmatic sulcus: the key window to suprachiasmatic and infrachiasmatic corridors.

BACKGROUND: Classically, the transtuberculum and transplanum approaches have been utilized to reach the suprachiasmatic and infrachiasmatic corridors. The aim of this study was to provide a better understanding of the key endoscopic endonasal anatomy of the suprachiasmatic and infrachiasmatic corridors provided through selective removal of the prechiasmatic sulcus (SRPS). METHOD: A SRPS was performed in 16 sides of 8 alcohol-fixed head specimens. Twenty anatomical measurements were collected on the suprachiasmatic and infrachiasmatic corridors. The transplanum and transtuberculum approaches were also performed. RESULTS: In the suprachiasmatic corridor, the SRPS exposed the anterior communicating artery (AComm) and the post-communicating segment of the anterior cerebral arteries in all the cases, while the pre-communicating segment of the anterior cerebral arteries, recurrent arteries of Heubner, and fronto-orbital arteries were visualized in 75% (12/16), 31% (5/16), and 69% (11/16) of cases, respectively. In the infrachiasmatic corridor, the ophthalmic segment of the internal carotid artery and superior hypophyseal arteries were always visible through the SRPS. The mean width and height of the prechiasmatic sulcus were 13.2 mm and 9.6 mm, respectively. The mean distances from the midpoint of the AComm to the anterior margin of the optic chiasm (OCh) was 5.3 mm. The mean width of the infrachiasmatic corridor was 12.3 mm at the level of the proximal margin of the ophthalmic segment of the internal carotid artery. The mean distances from the posterior superior limit of the pituitary stalk to the basilar tip and oculomotor nerve were 9.7 mm and 12.3 mm, respectively. CONCLUSIONS: The SRPS provides access to the main neurovascular and cisternal surgical landmarks of the suprachiasmatic and infrachiasmatic corridors. This anatomical area constitutes the key part of the approach to the suprasellar area. To afford adequate surgical maneuverability, the transplanum or transtuberculum approaches are usually a necessary extension.

CD9-positive cells in the intermediate lobe of the pituitary gland are important supplier for prolactin-producing cells in the anterior lobe.

A supply of hormone-producing cells from stem/progenitor cells is critical to sustain the endocrine activity of the pituitary gland. In the adenohypophysis composing the anterior and intermediate lobe (AL and IL, respectively), stem/progenitor cells expressing sex-determining region Y-box 2 (SOX2) and S100ß are located in the marginal cell layer (MCL) facing Rathke's cleft (primary niche) and the parenchyma of the AL (secondary niche). Our previous studies using mice and rats indicated that the tetraspanin superfamily CD9 and CD81 are expressed in S100ß/SOX2-positive cells of primary and secondary niches (named CD9/CD81/S100ß/SOX2-positive cell), and the cells located in the AL-side niches exhibit plasticity and multipotency. However, it is unclear whether CD9/CD81/S100ß/SOX2-positive cells in the IL-side primary niche are stem/progenitor cells for the AL or IL. Here, we successfully isolated pure CD9/CD81/S100ß/SOX2-positive cells from the IL-side primary niche. They had a higher level of S100ß and SOX2 mRNA and a greater pituisphere forming capacity than those of CD9/CD81/S100ß/SOX2-positive cells isolated from the AL. They also had capacity to differentiate into all types of adenohypophyseal hormone-producing cells, concomitantly with the loss of CD9 expression. Loss of CD9 and CD81 function in CD9/CD81/S100ß/SOX2-positive cells by siRNA treatment impaired prolactin cell differentiation. Consistently, in the pituitary gland of CD9/CD81 double knockout mice, dysgenesis of the MCL and a lower population of prolactin cells were observed. These results suggest that the CD9/CD81/S100ß/SOX2-positive cells in the MCL of the IL-side are potential suppliers of adult core stem cells in the AL.

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.

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.

Pubertal hormones predict sex-specific trajectories of pituitary gland volume during the transition from childhood to adolescence.

Pituitary gland volume (PGV) increases during childhood and adolescence in a sex-specific manner, and previous research suggests that puberty may be associated with PGV development. However, existing research to date has focused on sex hormones associated with gonadarche. Given the role of the pituitary gland in hypothalamic-pituitary-adrenal (HPA) axis function, the present study investigated associations between PGV development and HPA hormones that play a role in the earlier pubertal phase of adrenarche. Participants were a community sample of 249 children and early adolescents who participated in longitudinal brain imaging and pubertal assessments. Each participant provided data at one or two waves 1.5-3 years apart, resulting in 409 datasets that covered the age range 8-13 years. PGV was estimated from T1-weighted Magnetic Resonance Imaging (MRI) scans, and dehydroepiandrosterone (DHEA), its sulfate (DHEA-S) and testosterone were measured from saliva. Estradiol was measured for a subset of females. Parents reported on physical pubertal development. Linear mixed modeling was used to investigate associations between age, pubertal measures and PGV development. DHEA, DHEA-S and testosterone (in addition to physical maturation) explained variance in PGV development over and above age, and in a sex-dependent fashion. In all cases, associations were stronger, or only present in females. Estradiol was associated with PGV in females, but this did not appear to account for adrenarcheal hormone effects. Our findings suggest a key role for the hormones of adrenarche, the first biochemical phase of puberty, in PGV development. Further research is required to understand the sex-specific role of adrenarcheal and gonadarcheal hormones on the PGV across development.

Tumor T2 signal intensity and stalk angulation correlates with endocrine status in pituitary adenoma patients: a quantitative 7 tesla MRI study.

PURPOSE: Pituitary adenomas are common CNS tumors that can cause endocrine dysfunction due to hormone oversecretion and by mass effect on the normal gland. The study of pituitary adenomas and adjacent sellar anatomy with high-resolution 7 T MRI may further characterize endocrine dysfunction. The purpose of this study was to determine the efficacy of 7 T MRI in identifying radiological markers for endocrine function. METHODS: MR images obtained in 23 patients with pituitary adenomas were reviewed by consensus between three neuroradiologists. Landmarks and criteria were devised to measure radiological features of stalk, tumor, and normal gland. Fischer's exact tests and nominal logistic regression were performed. RESULTS: Mean cross-sectional area of the stalk just below the infundibular recess was 6.3 ± 3.7 mm2. Mean curvature and deviation angles were 34.2° ± 23.2° and 29.7° ± 17.3°, respectively. Knosp scores obtained differed between 7 T and lower field strength scans (P < 0.0001 [right] and P = 0.0006 [left]). Ability to characterize tumor was rated higher at 7 T compared with lower field MRI, P = 0.05. Confidence in visualizing normal gland was also higher using 7 T MRI, P = 0.036. The six hormone-secreting tumors had higher corrected T2 mean SI than non-secreting tumors (2.54 vs. - 0.38, P = 0.0196). Seven patients had preoperative hypopituitarism and had significantly greater stalk curvature angles than patients without hypopituitarism (71.7° vs. 36.55°, P = 0.027). CONCLUSION: Radiological characterization of pituitary adenomas and adjacent native pituitary tissue may benefit with the use of 7 T MRI. Corrected T2 SI of tumor may be a sensitive predictor of hormonal secretion and may be useful in the diagnostic work-up for pituitary adenoma. 7 T MRI may be valuable in identifying markers of endocrine function in patients with pituitary adenomas. Our results indicate that hormone-secreting tumors have higher T2-weighted SI and tumors associated with preoperative hypopituitarism have greater stalk curvature angles.

Effects of GnRH and the dual regulatory actions of GnIH in the pituitary explants and brain slices of Astyanax altiparanae males.

The pituitary gonadotropins, Fsh (follicle-stimulating hormone) and Lh (luteinizing hormone), regulate testicular development and functions in all vertebrates. At the pituitary, different signaling systems regulate the synthesis and secretion of the gonadotropins, such as the hypothalamic neuropeptides GnRH (gonadotropin-releasing hormone) and GnIH (gonadotropin-inhibitory hormone). While GnRH exerts stimulatory roles, the actions of GnIH remain controversial for many teleost species. Therefore, the aim of this study was to evaluate the in vitro effects of chicken GnRH2 (cGnRH2) and zebrafish GnIH-3 (zGnIH-3) on the male gonadotropin and GnRH system expression using pituitary explants and brain slices from a neotropical species with economical and ecological relevance, Astyanax altiparanae. Our results showed that in males, cGnRH2 increased fshb and lhb mRNA levels in the pituitary explants. Interestingly, zGnIH-3 has no effect on basal gonadotropin expression, however zGnIH-3 decreased the cGnRH2-induced fshb and lhb transcripts in male pituitary explants. In the male brain slices, zGnIH-3 showed stimulatory effects, increasing gnrh2 mRNA levels. Overall, our results suggested that GnIH seems to have dual regulatory actions on gonadotropin and GnRH2 expression of A. altiparanae males. This study provided basic information on endocrine regulation of A. altiparanae reproduction, and the obtained results will expand our knowledge, improving the reproductive management of this economically important freshwater species.

Measurements and Clinical Application of Anatomical Space for Transfrontal Pituitary Surgery Through Magnetic Resonance Imaging Reconstruction.

OBJECTIVE: This study aims to clarify the relative position of the normal important structures and anatomical spaces formed by the structures passed through during the transfrontal pituitary surgery, and discuss how to avoid some eloquent structures. METHODS: A total of 120 cases of magnetic resonance imaging images from normal adult brains were selected as the object of study and divided into male and female groups. The important adjacent structures of the pituitary passed through during the transfrontal pituitary surgery were marked on the reconstructed images. In all planes of the spaces passing through successively during the pituitary surgery, the morphological parameters such as the size, boundary, structure, and spatial extent of the spaces were measured. RESULTS: The size, boundary, structure, and spatial extent of the space between the 2 optic nerves, the space between the optic nerves and the pituitary stalk, and the space between the tuber cinereum and the interal carotid artery in the plane of the pituitary stalk were measured, the anterior part and the posterior part in male were shorter than those in female (P = 0.021; P = 0.029); no statistically significant difference was found in the measurements of the lengths and angles of these spaces. CONCLUSIONS: The authors' findings provide the surgeons with the detailed anatomical data and help to provide a morphological basis for intraoperative protection of the pituitary and vital adjacent structures and surgical approach.

Three-dimensional magnetic resonance-based morphometry of pituitary stalk.

PURPOSE: The pituitary or infundibular stalk is an anatomically important structure identified routinely in radiologic imaging for the evaluation of pituitary and suprasellar lesions. The morphometry of the pituitary stalk with 1.5 T MR images was useful in diagnosing the infundibular lesion and to assess the efficacy of treatment given by chemotherapy for many pathological conditions. The normative data for the length, the thickness of the stalk, and the infundibular recess are inadequate in the literature. There are no data regarding the morphometry of the pituitary stalk in the adult population. METHODS: One hundred and fifty normal brain MR images (75 males and 75 females) were analyzed for the evaluation of stalk and other parameters. Mean and the standard deviation were calculated. The unpaired t test was used to assess any significant difference between age-groups and gender. The intraclass coefficient correlation was used to analyze the inter-observer variability. RESULTS: The mean length of the stalk was 0.55 ± 0.16 mm. There was a significant difference (p < 0.05) in the length between the genders. The mean diameter of the stalk at the level of optic chiasma was 0.24 ± 0.06 mm, and the infundibular depth was 0.52 ± 0.12 mm. There was no significant difference between the genders in the thickness of the stalk and the depth of the recess. CONCLUSION: The normative data from the present study can be used as a screening tool for diagnosis as well as to assess the effect of treatment in pituitary infundibular lesions. These normative data shall be of help in the evaluation of stalk in various neurosurgical and endocrinological pathologies and lead the radiologist and endocrinologist in the early diagnosis and management of hypothalamo-pituitary axis diseases.

Landmark discoveries in elucidating the origins of the hypothalamic-pituitary system from the perspective of a basal vertebrate, sea lamprey.

The hypothalamic-pituitary (HP) system, which is specific to vertebrates, is considered to be an evolutionary innovation that emerged prior to or during the differentiation of the ancestral jawless vertebrates (agnathans) leading to the neuroendocrine control of many complex functions. Along with hagfish, lampreys represent the oldest lineage of vertebrates, agnathans (jawless fish). This review will highlight our discoveries of the major components of the lamprey HP axis. Generally, gnathostomes (jawed vertebrates) have one or two hypothalamic gonadotropin-releasing hormones (GnRH) while lampreys have three hypothalamic GnRHs. GnRH(s) regulate reproduction in all vertebrates via the pituitary. In gnathostomes, there are three classical pituitary glycoprotein hormones (luteinizing hormone, LH; follicle stimulating hormone, FSH; and thyrotropin, TSH) interacting specifically with three receptors, LH-R, FSH-R, and TSH-R, respectively. In general, FSH and LH regulate gonadal activity and TSH regulates thyroidal activity. In contrast to gnathostomes, we propose that lampreys only have two heterodimeric pituitary glycoprotein hormones, lamprey glycoprotein hormone (lGpH) and thyrostimulin, and two lamprey glycoprotein hormone receptors (lGpH-R I and -R II). Our existing data also suggest the existence of a primitive, overlapping yet functional hypothalamic-pituitary-gonadal (HPG) and HP-thyroidal (HPT) endocrine systems in lampreys. The study of basal vertebrates provides promising models for understanding the evolution of the hypothalamic-pituitary-thyroidal and gonadal axes in vertebrates. We hypothesize that the glycoprotein hormone/glycoprotein hormone receptor systems emerged as a link between the neuroendocrine and peripheral control levels during the early stages of gnathostome divergence. Our discovery of a functional HPG axis in lamprey has provided important clues for understanding the forces that ensured a common organization of the hypothalamus and pituitary as essential regulatory systems in all vertebrates. This paper will provide a brief snapshot of my discoveries, collaborations and latest findings including phylogenomic analyses on the origins, co-evolution and divergence of ligand and receptor protein families from the perspective of the lamprey hypothalamic-pituitary system.

A Cephalometric Analysis on Magnitudes and Shape of Sella Turcica.

Familiarity with the shape and dimensions of sella turcica is important to recognize and manage pathological conditions of pituitary gland as well as for orthodontic treatment planning. The present study aims to describe the morphology and dimensions of sella turcica from Indian population, using lateral cephalograms to set a reference data for comparison among different races. The study used 36 lateral skull radiographs of both sexes between age group of 13 to 18 years. Shape of sella turcica was noted by visual inspection. Length, height anterior, height median, height posterior, distance between frontonasal suture and mental spine to midpoint of posterior clinoid process, and tuberculum sella were measured using digital vernier caliper with reference to Frankfort line. The results of the study revealed that mean length, height anterior, height median, height posterior were larger in females than in males. The morphological types identified include pointed posterior clinoid process with rounded hypophyseal fossa, hooked posterior clinoid process with rounded hypophyseal fossa, hooked posterior clinoid process with flask-shaped hypophyseal fossa. These observations would be beneficial for the clinicians and orthodontists to design treatment planning in pathology of pituitary gland and in correcting dentofacial anomalies.

Connecting proximate mechanisms and evolutionary patterns: pituitary gland size and mammalian life history.

At the proximate level, hormones are known to play a critical role in influencing the life history of mammals, including humans. The pituitary gland is directly responsible for producing several hormones, including those related to growth and reproduction. Although we have a basic understanding of how hormones affect life history characteristics, we still have little knowledge of this relationship in an evolutionary context. We used data from 129 mammal species representing 14 orders to investigate the relationship between pituitary gland size and life history variation. Because pituitary gland size should be related to hormone production and action, we predicted that species with relatively large pituitaries should be associated with fast life histories, especially increased foetal and post-natal growth rates. Phylogenetic analyses revealed that total pituitary size and the size of the anterior lobe of the pituitary significantly predicted a life history axis that was correlated with several traits including body mass, and foetal and post-natal growth rates. Additional models directly examining the association between relative pituitary size and growth rates produced concordant results. We also found that relative pituitary size variation across mammals was best explained by an Ornstein-Uhlenbeck model of evolution, suggesting an important role of stabilizing selection. Our results support the idea that the size of the pituitary is linked to life history variation through evolutionary time. This pattern is likely due to mediating hormone levels but additional work is needed. We suggest that future investigations incorporating endocrine gland size may be critical for understanding life history evolution.

Sella turcica: an anatomical, endocrinological, and historical perspective.

INTRODUCTION: The sphenoid bone has a superior depression called the sella turcica, Latin for "Turkish saddle," where the pituitary gland is found. The availability of modern radiological imaging techniques has replaced plain radiography of the sella turcica in the investigation of hypothalamo-pituitary abnormalities. However, the size of the sella turcica, and smaller sella turcica size in particular, may cause pituitary dysfunction because of the changes in the structure of pituitary gland or may be associated with some genetic or acquired endocrine disorders. The name "sella turcica" is one of the most commonly used terms in everyday endocrine practice. METHODS: In this review, after a brief explanation of the anatomical and endocrinological features of the sella turcica had been given, a historical perspective of sella turcica nomenclature was presented for the first time. FINDINGS AND CONCLUSIONS: After Andreas Vesalius's description of it as a suitable cavity for the gland that receives the "phlegm of the brain" in De Humani Corporis Fabrica (1543), medical scholars began to use seat/saddle-related terms such as the ephippium, pars sellaris, sella equina, sella ossis, and sella sphenoidalis. The real designation of the sella turcica, however, was introduced to the anatomical nomenclature by the anatomist Adrianus Spigelius (1578-1625) in his famous work De Corpora Humanis Fabrica (1627).

Impact of orthodontic appliances on the quality of craniofacial anatomical magnetic resonance imaging and real-time speech imaging.

AIMS: The aim of this work was to investigate the effects of commonly used orthodontic appliances on the magnetic resonance (MR) image quality of the craniofacial region, with special interest in the soft palate and velopharyngeal wall using real-time speech imaging sequences and anatomical imaging of the temporomandibular joints (TMJ) and pituitaries. METHODS: Common orthodontic appliances were studied on 1.5 T scanner using standard spin and gradient echo sequences (based on the American Society for Testing and Materials standard test method) and sequences previously applied for high-resolution anatomical and dynamic real-time imaging during speech. Images were evaluated for the presence and size of artefacts. RESULTS: Metallic orthodontic appliances had different effects on image quality. The most extensive individual effects were associated with the presence of stainless steel archwire, particularly if combined with stainless steel brackets and stainless steel molar bands. With those appliances, diagnostic quality of magnetic resonance imaging speech and palate images will be most likely severely degraded, or speech imaging and imaging of pituitaries and TMJ will be not possible. All non-metallic, non-metallic with Ni/Cr reinforcement or Ni/Ti alloys appliances were of little concern. LIMITATIONS: The results in the study are only valid at 1.5 T and for the sequences and devices used and cannot necessarily be extrapolated to all sequences and devices. Furthermore, both geometry and size of some appliances are subject dependent, and consequently, the effects on the image quality can vary between subjects. Therefore, the results presented in this article should be treated as a guide when assessing the risks of image quality degradation rather than an absolute evaluation of possible artefacts. CONCLUSIONS: Appliances manufactured from stainless steel cause extensive artefacts, which may render image non-diagnostic. The presence and type of orthodontic appliances should be always included in the patient's screening, so the risks of artefacts can be assessed prior to imaging. Although the risks to patients with fixed orthodontic appliances at 1.5 T MR scanners are low, their secure attachment should be confirmed prior to the examination.

Estimating volumes of the pituitary gland from T1-weighted magnetic-resonance images: effects of age, puberty, testosterone, and estradiol.

The pituitary gland is a key structure in the hypothalamic-pituitary-gonadal (HPG) axis--it plays an important role in sexual maturation during puberty. Despite its small size, its volume can be quantified using magnetic resonance imaging (MRI). Here, we study a cohort of 962 typically developing adolescents from the Saguenay Youth Study and estimate pituitary volumes using a newly developed multi-atlas segmentation method known as the MAGeT Brain algorithm. We found that age and puberty stage (controlled for age) each predicts adjusted pituitary volumes (controlled for total brain volume) in both males and females. Controlling for the effects of age and puberty stage, total testosterone and estradiol levels also predict adjusted pituitary volumes in males and pre-menarche females, respectively. These findings demonstrate that the pituitary gland grows during adolescence, and its volume relates to circulating plasma-levels of sex steroids in both males and females.

Thyrotrophin in the pars tuberalis triggers photoperiodic response.

Molecular mechanisms regulating animal seasonal breeding in response to changing photoperiod are not well understood. Rapid induction of gene expression of thyroid-hormone-activating enzyme (type 2 deiodinase, DIO2) in the mediobasal hypothalamus (MBH) of the Japanese quail (Coturnix japonica) is the earliest event yet recorded in the photoperiodic signal transduction pathway. Here we show cascades of gene expression in the quail MBH associated with the initiation of photoinduced secretion of luteinizing hormone. We identified two waves of gene expression. The first was initiated about 14 h after dawn of the first long day and included increased thyrotrophin (TSH) beta-subunit expression in the pars tuberalis; the second occurred approximately 4 h later and included increased expression of DIO2. Intracerebroventricular (ICV) administration of TSH to short-day quail stimulated gonadal growth and expression of DIO2 which was shown to be mediated through a TSH receptor-cyclic AMP (cAMP) signalling pathway. Increased TSH in the pars tuberalis therefore seems to trigger long-day photoinduced seasonal breeding.

The buccohypophyseal canal is an ancestral vertebrate trait maintained by modulation in sonic hedgehog signaling.

BACKGROUND: The pituitary gland is formed by the juxtaposition of two tissues: neuroectoderm arising from the basal diencephalon, and oral epithelium, which invaginates towards the central nervous system from the roof of the mouth. The oral invagination that reaches the brain from the mouth is referred to as Rathke's pouch, with the tip forming the adenohypophysis and the stalk disappearing after the earliest stages of development. In tetrapods, formation of the cranial base establishes a definitive barrier between the pituitary and oral cavity; however, numerous extinct and extant vertebrate species retain an open buccohypophyseal canal in adulthood, a vestige of the stalk of Rathke's pouch. Little is currently known about the formation and function of this structure. Here we have investigated molecular mechanisms driving the formation of the buccohypophyseal canal and their evolutionary significance. RESULTS: We show that Rathke's pouch is located at a boundary region delineated by endoderm, neural crest-derived oral mesenchyme and the anterior limit of the notochord, using CD1, R26R-Sox17-Cre and R26R-Wnt1-Cre mouse lines. As revealed by synchrotron X-ray microtomography after iodine staining in mouse embryos, the pouch has a lobulated three-dimensional structure that embraces the descending diencephalon during pituitary formation. Polaris(fl/fl); Wnt1-Cre, Ofd1(-/-) and Kif3a(-/-) primary cilia mouse mutants have abnormal sonic hedgehog (Shh) signaling and all present with malformations of the anterior pituitary gland and midline structures of the anterior cranial base. Changes in the expressions of Shh downstream genes are confirmed in Gas1(-/-) mice. From an evolutionary perspective, persistence of the buccohypophyseal canal is a basal character for all vertebrates and its maintenance in several groups is related to a specific morphology of the midline that can be related to modulation in Shh signaling. CONCLUSION: These results provide insight into a poorly understood ancestral vertebrate structure. It appears that the opening of the buccohypophyseal canal depends upon Shh signaling and that modulation in this pathway most probably accounts for its persistence in phylogeny.

Topographic variations of the optic chiasm and the pituitary stalk: a morphometric study based on midsagittal T2-weighted MR images.

PURPOSE: This study was conducted to characterize topographic variations of the optic chiasm (OC) and the pituitary stalk (PS) in situ based on MR images. METHODS: Normal T2-weighted midsagittal MR images were obtained in 157 children and 323 adults. The height of OC (PC) and the inclination angle of PS (PS-AP angle) were measured in each case. All chiasms were classified into prefixed, normal and postfixed types, and low, medium and high types, respectively. All stalks were performed classification (prefixed, centered and postfixed PS) and grading (Grade 1-3 according to the relationship between PS and the dorsum sellae), respectively. RESULTS: PC averaged 4.33 ± 1.59 mm. Adults had a greater PC (P = 0.023) than children. There were 80 (16.7 %) prefixed, 354 (73.8 %) normal and 46 (9.6 %) postfixed chiasms, and 112 (23.3 %), 295 (61.5 %) and 73 (15.2 %) cases with low, medium and high OC, respectively. High OC was more frequent in adults than in children (P = 0.001). The mean PS-AP angle of the whole group was 59.47 ± 8.62º. Children had a greater PS-AP angle than adults (P = 0.012). Adults had a greater percentage of postfixed (P = 0.000) and grade 3 (P = 0.000) PS than children, whereas centered (P = 0.002) and grade 1 (P = 0.001) PS were more prevalent in children than in adults. CONCLUSIONS: The classifications of OC and PS based on MR images reflect the topographic variations of their real position in vivo. It would be helpful to identify and characterize the anomalies involving OC and PS and understand the anatomical and physiological influence in pathological situations.

[The history of the pituitary gland: evolution of mental representation and concepts over time]. / Une histoire d'hypophyse. Evolution des représentations et des concepts au cours du temps.

The hypothalamo pituitary axis, as the true conductor of the endocrine orchestra, is frequently involved in a large variety of pathological conditions such as acromegaly, behavioral disorders, obesity or dwarfism. It is paradoxical to note that, in spite of its importance, this system has been almost ignored by the physiologists of the late centuries. From the physiological conceptions of the physicians and philosophers of antiquity to the theories of the medieval and of the Renaissance physiologists, we will try to understand why the role of pituitary remained so long unrecognized.

PitSurgRT: real-time localization of critical anatomical structures in endoscopic pituitary surgery.

PURPOSE: Endoscopic pituitary surgery entails navigating through the nasal cavity and sphenoid sinus to access the sella using an endoscope. This procedure is intricate due to the proximity of crucial anatomical structures (e.g. carotid arteries and optic nerves) to pituitary tumours, and any unintended damage can lead to severe complications including blindness and death. Intraoperative guidance during this surgery could support improved localization of the critical structures leading to reducing the risk of complications. METHODS: A deep learning network PitSurgRT is proposed for real-time localization of critical structures in endoscopic pituitary surgery. The network uses high-resolution net (HRNet) as a backbone with a multi-head for jointly localizing critical anatomical structures while segmenting larger structures simultaneously. Moreover, the trained model is optimized and accelerated by using TensorRT. Finally, the model predictions are shown to neurosurgeons, to test their guidance capabilities. RESULTS: Compared with the state-of-the-art method, our model significantly reduces the mean error in landmark detection of the critical structures from 138.76 to 54.40 pixels in a 1280 × 720-pixel image. Furthermore, the semantic segmentation of the most critical structure, sella, is improved by 4.39% IoU. The inference speed of the accelerated model achieves 298 frames per second with floating-point-16 precision. In the study of 15 neurosurgeons, 88.67% of predictions are considered accurate enough for real-time guidance. CONCLUSION: The results from the quantitative evaluation, real-time acceleration, and neurosurgeon study demonstrate the proposed method is highly promising in providing real-time intraoperative guidance of the critical anatomical structures in endoscopic pituitary surgery.