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.

Variation in the Anatomy of the Normal Human Optic Chiasm: An MRI Study.

BACKGROUND: Compression of the optic chiasm typically leads to bitemporal hemianopia. This implies that decussating nasal fibers are selectively affected, but the precise mechanism is unclear. Stress on nasal fibers has been investigated using finite element modeling but requires accurate anatomical data to generate a meaningful output. The precise shape of the chiasm is unclear: A recent photomicrographic study suggested that nasal fibers decussate paracentrally and run parallel to each other in the central arm of an "H." This study aimed to determine the population variation in chiasmal shape to inform future models. METHODS: Sequential MRI scans of 68 healthy individuals were selected. 2D images of each chiasm were created and analyzed to determine the angle of elevation of the chiasm, the width of the chiasm, and the offset between the points of intersection of lines drawn down the centers of the optic nerves and contralateral optic tracts. RESULTS: The mean width of the chiasm was 12.0 ± 1.5 mm (SD), and the mean offset was 4.7 ± 1.4 mm generating a mean offset:width ratio of 0.38 ± 0.09. No chiasm had an offset of zero. The mean incident angle of optic nerves was 56 ± 7°, and for optic tracts, it was 51 ± 7°. CONCLUSIONS: The human optic chiasm is "H" shaped, not "X" shaped. The findings are consistent with nasal fibers decussating an average of 2.4 mm lateral to the midline before travelling in parallel across the midline. This information will inform future models of chiasmal compression.

The neural pathway midline crossing theory: a historical analysis of Santiago Rámon y Cajal's contribution on cerebral localization and on contralateral forebrain organization.

Throughout history, many scientists have wondered about the reason for neural pathway decussation in the CNS resulting in contralateral forebrain organization. Hitherto, one of the most accepted theories is the one described by the renowned Spanish physician, Santiago Rámon y Cajal at the end of the 19th century. This Nobel Prize winner, among his many contributions to science, gave us the answer to this question: the key lies in the optic chiasm. Based on the fact that the ocular lenses invert the image formed in the retina, Cajal explained how the decussation of the fibers in the optic chiasm is necessary to obtain a continuous image of the outside in the brain. The crossing of the tactile and motor pathways occurred posteriorly as a compensatory mechanism to allow the cortical integration of the sensory, motor, and visual functions. This theory had a great influence on the scientific community of his time, and maintains its importance today, in which none of the theories formulated to date has managed to entirely refute Cajal's. In addition, the decussation of neural pathways plays a significant role in different diseases, especially in the recovery process after a hemispheric lesion and in several congenital pathologies. The advantages of cerebral lateralization have also recently been published, although the evolutionary connection between fiber decussation and cortical function lateralization remains a mystery to be solved. A better understanding of the molecular and genetic substrates of the midline crossing processes might result in significant clinical advances in brain plasticity and repair.

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.

Prechiasmatic sulcus and optic strut: an anatomic study in dry skulls.

BACKGROUND: Although safe surgical access to the cavernous sinus is related to understanding the anatomical and ethnic variants of the prechiasmatic sulcus and the optic strut, there remains a paucity of studies of the morphology and the bony relationships in the region. The present study provides a systematic morphological and morphometric analysis of the sulcal region and the optic strut anatomy and their relations in a Greek population. METHODS: The interoptic distance, length of planum sphenoidale, sulcal length and sulcal angle was determined in 96 Greek adult dry skulls. The prechiasmatic sulci and optic struts were morphologically classified and association of sulcal region measures according to type of prechiasmatic sulcus and optic strut were examined. RESULTS: Mean interoptic distance was 1.69 ± 0.25 cm; sulcal length, 0.72 ± 0.18 cm; length of planum sphenoidale, 1.86 ± 0.32 cm; sulcal angle, 24.05 ± 17.17°. The sulcal angle was significantly smaller in female skulls compared to males (14.82 ± 12.43 vs 28.29 ± 15.24; p < 0.05). Type I (narrow, steep) prechiasmatic sulci were the most commonly observed (35.8%), followed by Type IV (wide, flat) (32.1%), Type II (narrow, flat) (18.5%) and, finally, Type III (wide, steep) sulci (13.6%). The optic strut was presulcal in 8.3% of specimens, sulcal in 31%, postsulcal in 41.7% and asymmetric in 19%. CONCLUSIONS: The present study augments the current knowledge of the morphology of key anatomical landmarks, prechiasmatic sulcus and the optic strut, for cavernous sinus surgery and indicates population and gender differences. We report significant anatomical variations in the prechiasmatic sulcus, optic strut and surrounding structures. In addition to providing a better understanding of the anatomical landmarks, necessary for the safe navigation in transcranial and endoscopic procedures, the present results also suggest that surgeons must consider population differences in determining the anatomical landmarks and navigation points in the sellar region.

Can the angle between optic nerves indicate whether optic chiasm is prefixed, normofixed or postfixed? An anatomical study with radiologic and neurosurgical implications.

PURPOSE: The objective of this study was to measure the angle (Interneural angle, INA) between intracranial segments of optic nerves (ISON), and to look for any relation between it and the relative anteroposterior location (RAPL) of the optic chiasm (OC)-viz. prefixed, normofixed and postfixed. METHODS: The sample comprised of 100 autopsy specimens from South Indian population. INA was measured using software-aided processing of digital photographs. Length of the ISON was measured on each side using Vernier calipers. RAPL of the OC was noted during dissection. These were analysed with statistical methods. RESULTS: RAPL of OC was found to be prefixed in 24 %, normofixed in 65 % and postfixed in 11 %. The INA had an overall mean of 69.9° (SD 9.29°). ANOVA confirmed statistically significant difference in INA among different groups; the corresponding mean value for the group was as follows: 79.61° (prefixed), 68.10° (normofixed) and 59.48° (postfixed). ROC curve was plotted for the use of various 'cut off' values of INA to 'diagnose' prefixed OC; an INA ≥71.4° was seen to diagnostically correlate with prefixed OC with 83.3 % sensitivity and 75 % specificity. CONCLUSIONS: The INA is wider when OC is prefixed, intermediate when normofixed and narrowed when postfixed. This observation throws light on the possibility of using INA as a marker of RAPL of OC. As INA can be measured in axial MRI sections, it can be used in differentiation of the cases with prefixed OC from others during pre-operative work up for pituitary surgeries and to identify individuals 'at risk' during subfrontal approach for pituitary lesions.

Understanding fiber mixture by simulation in 3D Polarized Light Imaging.

3D Polarized Light Imaging (3D-PLI) is a neuroimaging technique that has opened up new avenues to study the complex architecture of nerve fibers in postmortem brains. The spatial orientations of the fibers are derived from birefringence measurements of unstained histological brain sections that are interpreted by a voxel-based analysis. This, however, implies that a single fiber orientation vector is obtained for each voxel and reflects the net effect of all comprised fibers. The mixture of various fiber orientations within an individual voxel is a priori not accessible by a standard 3D-PLI measurement. In order to better understand the effects of fiber mixture on the measured 3D-PLI signal and to improve the interpretation of real data, we have developed a simulation method referred to as SimPLI. By means of SimPLI, it is possible to reproduce the entire 3D-PLI analysis starting from synthetic fiber models in user-defined arrangements and ending with measurement-like tissue images. For the simulation, each synthetic fiber is considered as an optical retarder, i.e., multiple fibers within one voxel are described by multiple retarder elements. The investigation of different synthetic crossing fiber arrangements generated with SimPLI demonstrated that the derived fiber orientations are strongly influenced by the relative mixture of crossing fibers. In case of perpendicularly crossing fibers, for example, the derived fiber direction corresponds to the predominant fiber direction. The derived fiber inclination turned out to be not only influenced by myelin density but also systematically overestimated due to signal attenuation. Similar observations were made for synthetic models of optic chiasms of a human and a hooded seal which were opposed to experimental 3D-PLI data sets obtained from the chiasms of both species. Our study showed that SimPLI is a powerful method able to test hypotheses on the underlying fiber structure of brain tissue and, therefore, to improve the reliability of the extraction of nerve fiber orientations with 3D-PLI.

Photoreceptor projections and receptive fields in the dorsal rim area and main retina of the locust eye.

In many insect species, photoreceptors of a small dorsal rim area of the eye are specialized for sensitivity to the oscillation plane of polarized skylight and, thus, serve a role in sky compass orientation. To further understand peripheral mechanisms of polarized-light processing in the optic lobe, we have studied the projections of photoreceptors and their receptive fields in the main eye and dorsal rim area of the desert locust, a model system for polarization vision analysis. In both eye regions, one photoreceptor per ommatidium, R7, has a long visual fiber projecting through the lamina to the medulla. Axonal fibers from R7 receptors of the dorsal rim area have short side branches throughout the depth of the dorsal lamina and maintain retinotopic projections to the dorsal medulla following the first optic chiasma. Receptive fields of dorsal rim photoreceptors are considerably larger (average acceptance angle 33°) than those of the main eye (average acceptance angle 2.04°) and, taken together, cover almost the entire sky. The data challenge previous reports of two long visual fibers per ommatidium in the main eye of the locust and provide data for future analysis of peripheral networks underlying polarization opponency in the locust brain.

The optic chiasm.

The optic chiasm is formed when the optic nerves come together in order to allow for the crossing of fibers from the nasal retina to the optic tract on the other side. This enables vision from one side of both the eyes to be appreciated by the occipital cortex of the opposite side. This review makes note of the embryology, anatomy and vascular supply of the optic chiasm, then discusses the clinical syndromes associated with chiasmal disease, and the diseases which commonly influence its function.

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.

Accuracy of CT and MRI for contouring the feline optic apparatus for radiation therapy planning.

Consistency and accuracy in normal tissue contouring in radiotherapy planning is important for comparison of dosimetry and toxicity data between studies. The purpose of this study was to determine whether magnetic resonance imaging (MRI) improves the accuracy of optic apparatus contouring as compared with computed tomography (CT) in both normal and acromegalic cats, and to construct a reference contour of the feline optic apparatus. Both CT and MRI were performed on cadavers of four healthy cats, as well as on five radiotherapy patients with feline acromegaly. Contours of the optic apparatus were drawn for each imaging study. The volume, center of mass, and the degree of concordance and mismatch were determined for each, and compared with a reference standard. Precontrast CT was found to overestimate volume as compared with MRI in acromegalic cats; no other statistically significant differences were identified in the volume, concordance index or mismatch index values of normal or acromegalic cats. Contours derived from T2-wieghted MRI were subjectively considered to best match the reference standard. The caudal margin of the optic chiasm and the optic tracts were difficult to confidently contour regardless of which imaging modality and/or sequence was used. In conclusion, findings from the current study supported the use of a combination of CT and MR images and a priori knowledge of the shape of the optic apparatus to guide accurate contouring, especially where image contrast is not sufficient to clearly delineate the margins. Guidelines for feline optic apparatus contouring developed in this study can be used for future studies.

Delineation of optic nerves and chiasm in close proximity to large suprasellar tumors with contrast-enhanced FIESTA MR imaging.

PURPOSE: To evaluate whether contrast material-enhanced (CE) fast imaging employing steady-state acquisition (FIESTA) can depict the anterior optic pathways in patients with large suprasellar tumors. MATERIALS AND METHODS: Institutional review board approval was obtained. Twenty-eight patients with large suprasellar tumors undergoing surgical treatment (19 pituitary adenomas, six meningiomas, and three additional miscellaneous tumors) underwent preoperative magnetic resonance (MR) imaging, including CE FIESTA, at 3.0 T. Two radiologists assessed the visibility of five segments of the optic pathways (bilateral optic nerves and optic tracts, optic chiasm) with CE FIESTA and conventional MR imaging, including thin-section coronal T2-weighted imaging and CE T1-weighted imaging, by using a three-point scale. Moreover, the preoperative signal intensity of the optic pathways was correlated with pre- and postoperative visual impairment to determine whether high signal intensity at CE FIESTA is predictive of persistence of visual impairment after surgery. The χ(2) test was used to compare scores assigned to CE FIESTA and conventional MR images. RESULTS: The percentage of anterior optic pathways rated as visible was significantly higher with CE FIESTA than with conventional MR imaging (100% [140 of 140 segments] vs 78% [109 of 140 segments], P < .05). Thirty-one of the 140 segments (22%) were not depicted with conventional MR imaging; all of these 31 segments were visualized with CE FIESTA. For 12 patients who underwent transcranial surgery, the anatomic locations of the optic pathways at CE FIESTA were compatible with the surgical findings. CE FIESTA helped predict persistent visual impairment after surgical treatment with a sensitivity of 75% (three of four patients) and a specificity of 96% (23 of 24 patients). The accuracy of CT FIESTA in the prediction of visual loss was significantly higher than that of T2-weighted imaging (93% [26 of 28 patients] vs 50% [14 of 28 patients], P < .05). CONCLUSION: CE FIESTA is useful for the preoperative localization of the anterior optic pathways in patients with large suprasellar tumors and offers the potential to predict persistent visual impairment after decompression.

Forward signaling by EphB1/EphB2 interacting with ephrin-B ligands at the optic chiasm is required to form the ipsilateral projection.

EphB receptor tyrosine kinases direct axonal pathfinding through interactions with ephrin-B proteins following axon-cell contact. As EphB:ephrin-B binding leads to bidirectional signals, the contributions of signaling into the Eph-expressing cell (forward signaling) or the ephrin-expressing cell (reverse signaling) cannot be assigned using traditional protein null alleles. To determine if EphB1 is functioning solely as a receptor during axon pathfinding, a new knock-in mutant mouse was created, EphB1(T-lacZ), which expresses an intracellular-truncated EphB1-ß-gal fusion protein from the endogenous locus. As in the EphB1(-/-) protein null animals, the EphB1(T-lacZ/T-lacZ) homozygotes fail to form the ipsilateral projecting subpopulation of retinal ganglion cell axons. This indicates that reverse signaling through the extracellular domain of EphB1 is not required for proper axon pathfinding of retinal axons at the optic chiasm. Further analysis of other EphB and ephrin-B mutant mice shows that EphB1 is the preferred receptor of ephrin-B2 and, to a lesser degree, ephrin-B1 in mediating axon guidance at the optic chiasm despite the coexpression of EphB2 in the same ipsilaterally projecting retinal axons.

Optimum b value for resolving crossing fibers: a study with standard clinical b value using 1.5-T MR.

INTRODUCTION: We sought to investigate the optimum b value for resolving crossing fiber using high-angular resolution diffusion imaging (HARDI)-based multi-tensor tractography. The study tested the standard b values that are commonly used in the routine clinical setting. METHODS: Ten normal volunteers (five men and five women) with a mean age of 26.3 years (range, 22-32 years) were scanned using a 1.5-T clinical magnetic resonance unit. Single-shot echo-planar imaging was used for diffusion-weighted imaging with a diffusion-sensitizing gradient in 32 orientations. The b values of 700, 1,400, 2,100, and 2,800 s/m(2) were used. Data postprocessing was performed using multi-tensor methods. The depiction of the optic nerves, optic tracts, and decussation of superior cerebellar peduncles were assessed. RESULTS: The depictions of the nerve fibers were independent of the b values tested. CONCLUSION: The depiction of crossing fibers by HARDI-based multi-tensor tractography is not substantially influenced by b values ranging from 700 to 2,800 s/m(2). Thus, the optimum b value within this range may be the lowest one considering the higher signal to noise ratio.

Sectional anatomy of the olfactory pathways.

AIM: The purpose of this study was to provide practical anatomic data for imaging diagnosis of olfactory pathways and operation of nasal cavity and anterior cranial fossae. METHODS: Sectional anatomy of olfactory pathways were investigated specially on 17 sets of Chinese adult cadavers and 9 sets of serial magnetic resonance (MR) imaging of normal adult on serial transverse, sagittal and coronal sections respectively. RESULTS: We recognized olfactory bulb, olfactory tract, medial and lateral olfactory striae, olfactory trigone, anterior perforated substance and piriform lobe on transverse, sagittal and coronal sections respectively. On the 5-7 serial coronal sections from crista galli of ethmoid bone to the optic chiasm, the cusp ellipse olfactory bulb and the triangular tract were situated in the shallow part of the olfactory sulcus. CONCLUSION: The olfactory bulb and olfactory tract lay tightly on the ethmoidal cribriform plate and jugum sphenoidale, in the olfactory cistern of the shallow part of the olfactory sulcus, the ethmoid sinus and sphenoid sinus inferiorly.

Extended endoscopic endonasal approach to the suprasellar parachiasmatic cisterns: anatomic study.

OBJECTIVE: The objective of this study is to recognize the available endoscopic routes during approaches to the suprasellar region and the surgical endoscopic anatomy of the related neurovascular structures. MATERIAL AND METHODS: Extended endoscopic endonasal approach to the suprasellar region (EEASR) through the planum sphenoidale was performed in five fresh adult cadavers. The anatomic characteristics of the suprasellar parachiasmatic cisterns were studied and documented following the resection of the planum sphenoidale and opening the dura to expose the anterior incisural space. RESULTS: Two separate surgical corridors could be used during EEASR: one above and the other below the chiasm. The suprachiasmatic route exposed the gyrus recti, interhemispheric fissure, anterior cerebral artery complex, the lamina terminalis, and through this structure the anterior recess of the third ventricle. The subchiasmatic route exposed the pituitary stalk, superior hypophyseal artery, supraclinoidal internal carotid artery, origin of the ophthalmic artery, anterior choroidal artery, posterior communicating artery, uncus, optic tract, basilar artery and its bifurcation, pons, posterior cerebral artery, superior cerebellar artery, and oculomotor nerve. CONCLUSION: The EEASR, a minimally invasive route to suprasellar parachiasmatic area, provided wide exposure of the basal cisterns. The surgical areas that were accessed through the subchiasmatic corridor could be divided into a medial part that included the interpeduncular and prepontine cisterns and a lateral part that contained carotid and sylvian cisterns superiorly and the crural and ambient cisterns inferiorly.

Topographic variations of the optic chiasm and the foramen diaphragma sellae.

Pituitary adenomas can expand upward through the foramen diaphragma sellae (FDS), compress the visual pathways on the suprasellar region, and cause diverse visual defects. However, the relationship between the FDS and the visual pathway has not been thoroughly clarified. This study was thus performed to determine the topographic relationship between these two structures. One hundred heads of adult cadavers were examined in this study. The FDS was classified into five types (Ia, Ib, Ic, II, and III) according to its location relative to the four parts of suprasellar region of the visual pathways. The midpoint of the optic chiasm (OC) was located on the midline passing through the crista galli in 70% of cases, but to the left and right sides of the midline in 9 and 21% of cases, respectively. The FDS was completely covered by OC in 30% of the cases, but it was partly seen superiorly in 70%. The pituitary infundibulum passed mainly through the center middle or posterior middle part of nine partitions of the FDS. The horizontal and vertical diameters of the foramen were 7.9 +/- 2.0 and 7.6 +/- 1.9 mm, respectively. The length of the optic nerve was 9.7 +/- 1.9 mm on the left side and 9.5 +/- 1.9 mm on the right side. The angle between the optic nerve and the midline was 34.5 degrees +/- 5.7 degrees on the left side and 36.0 degrees +/- 6.3 degrees on the right side. The results of this study are expected to further the current knowledge of the topographic anatomy on suprasellar structures.

The anatomic variations and surgical windows among optic chiasm/nerves and carotid arteries in the sellar region play a role in choosing the best surgical approaches: A Cadaveric study.

OBJECTIVE: Understanding the relationship between the carotid artery, optic nerve and the anterior clinoid process is the basis of surgical approaches performed in the subchiasmal region. The location of the optic chiasm, the length of the optic nerves, and the distance and angle between the optic nerves determine the route of surgical approaches. We have determined the types of optic chiasm to study the relationship between vascular and neural structures in this region. MATERIALS AND METHODS: Thirty autopsy specimens were investigated at the Bursa Forensic Medicine Institute for optic chiasm types and the relationship between the neural and vascular anatomical structures of the sellar-parasellar and subchiasmal region was examined between June 2016 and November 2016. RESULTS: In this study, 4 prefix types (13%), 6 postfix types (20%), and 20 central types (67%) of chiasm were defined. Furthermore, we measured this angle between two optic nerves, which indirectly shows the location of chiasm according to the diaphragma sellae, and then detected the mean value of this angle as 87.1±11.6°. The "limit" value to designate a chiasm as prefix was measured in the current study as ≥101.1°. The angle between optic nerves ranged from a mean value of 69.9±3.7° in 6 cases with postfix chiasm, to a mean value of 104.0±2.1° in 4 cases with prefix chiasm and a mean value of 88.8±6.7° in 20 cases with central chiasm. CONCLUSION: In this study, we showed that the relationship among optic chiasma types, optic nerves and bony and vascular structures around the sellar area was effective at determining the surgical approach to this region.