Sellar region related to the transsphenoidal endoscopic approach of pituitary surgery.

INTRODUCTION: Transsphenoidal endoscopic approach gives significant advantages in the surgery of pituitary adenomas. A sound knowledge of the anatomy is essential for the surgeons to perform the procedure in a safe and efficient way. This study aims to provide a better understanding of the complex anatomical structures involved in the transsphenoidal approach and to increase familiarity with the endoscopic views and associated skills. PATIENTS AND METHODS: Computed tomographic angiography images from 122 individuals were used for measurements between landmark structures that are relevant to these surgeries. The parameters including the size, shape, and available angles were measured. RESULTS: The angle between 2 lines that are from the sphenoidal rostrum to the middle point of tuberculum sellae and to the tangential point of a tangent which is through the center of sphenoidal rostrum to the pituitary fossa (AR) was 30.62 ± 4.70 degrees; the angle between 2 lines that are from the unilateral sphenoidal rostrum to the bilateral nearest point of the 2 internal carotid arteries within the area of sellar region (AI) was 39.06 ± 9.82 degrees; the anteroposterior diameter of the pituitary fossa (SP) was 11.07 ± 1.36 mm; the vertical diameter of the pituitary fossa (BH) was 7.20 ± 1.46 mm; the distance from the middle point of tuberculum sellae to the lowest point of the pituitary (SB) was 9.59 ± 1.37 mm; the angle between line SB and the horizontal plane (ASB) was 49.29 ± 7.51 mm; the width of tuberculum sellae was (SD) 10.16 ± 1.47 mm; the width of the intermediate part of the pituitary fossa was (BD) 12.09 ± 2.01 mm; the width of the posterior wall of the pituitary fossa (PD) was 12.84 ± 1.57 mm; and the ply of the bone of the front (PB) and bottom (PA) of pituitary fossa were 0.75 ± 0.22 mm and 0.91 ± 0.26 mm, respectively. CONCLUSIONS: These measurements can help to understand the complicated anatomical structures around the pituitary fossae and can contribute to ensure the efficiency and success of the surgery as well.

Anatomical study of cavernous segment of the internal carotid artery and its relationship to the structures in sella region.

INTRODUCTION: The shape and position of the cavernous segment of the internal carotid artery (CSICA) are complicated, which makes the surgeries around it difficult. There were many reports about the primary event of internal carotid artery injury resulting in hemorrhage during transsphenoidal resection of pituitary tumors. The anatomical relationship between CSICA and the structures in the sella region around can explain its mechanism. PURPOSE: We study the CSICA and its positional relationship to some stationary structures in the sellar region to locate CSICA and prevent it from injuring in the process of transsphenoidal surgery. MATERIAL AND METHODS: Computed topographic angiography images of 144 internal carotid arteries in individuals were reviewed. The distance from CSICA to midpoint of sella bottom (SB) and the angle between line BA and line BM were measured in the coronal plane, which is across the middle point of SB. The vertical distance from the anterior curve segment of CSICA to the top edge of the sphenoid sinus was measured in people with sphenoid sinus of types III and IV. The horizontal distance between the midpoint of the posterior curve segment and the coronal middle line of SB was measured in the sagittal plane after multiplanar reformation. RESULTS: The mean (SD) distances from the CSICA to the midpoint of SB were 11.25 (3.35) mm in the right and 11.06 (2.98) mm in the left, and the mean (SD) angles between line BA and line BM were 74.2 (2.16) degrees in the right and 73.5 (2.33) degrees in the left. The mean (SD) vertical distance between the anterior curve segment of the CSICA and the top edge of the sphenoid sinus was -0.62 (0.96) mm, the mean (SD) of the right side was -0.68 (1.24) mm, and the mean (SD) of the left was -0.54 (1.15) mm. The mean (SD) horizontal distance between the midpoint of PS segment and the coronal middle line of SB was 6.41 (1.94) mm in the right and 6.31 (1.33) mm in the left. CONCLUSIONS: The data in our study are valuable for surgeons in real clinical practice to achieve the best possible surgical outcome and maximize safety, and they also contribute to the understanding of the anatomy of CSICA and the structures around.

Morphological study of transpterional-insula approach using volume rendering.

This study describes the measurements of inferior circular insular sulcus (ICIS) and the shortest distance from ICIS to the temporal horn and determines the position of the incision, which does less harm to the temporal stem in the transpterional-insula approach using volume-rendering technique. Results of the research showed that one-third point over the anterior side of ICIS may be the ideal penetration point during operation. And there is no difference between 2 hemispheres (P < 0.05). The comparison with the results of ICIS from other Chinese researches demonstrated that volume rendering is a reliable method in insular research that enables mass measurements.

Location of supraorbital foramen/notch and infraorbital foramen with reference to soft- and hard-tissue landmarks.

The purpose of the present study was to determine the locations of the supraorbital foramen (SOF) and the infraorbital foramen (IOF) relative to soft- and hard-tissue landmarks. It will provide more accurate data for dental and facial surgery. Twenty embalmed adult cadavers (40 sides; 16 men, 4 women) were dissected to expose the SOFs and IOFs, and another 46 skulls (92 sides) were also measured for further study. The locations of the SOFs and IOFs were evaluated with direct and photographic measurements. The data gained were analyzed by statistical method. The horizontal distances between the SOFs/IOFs and the medial canthus to the distance between the medial canthus and the lateral canthus ratios have been measured, and their confidence intervals are 0.22 to 0.31 and 0.34 to 0.49, respectively, and their linear regression equations are EF = 0.58 CF + 25.02 (unit: mm) and EF = 0.51 DG + 24.20 (unit: mm). The vertical distance between IOFs/SOFs and the medial/lateral canthi are 25.09 ± 3.36 mm/23.91 ± 3.31 mm and 25.75 ± 3.34 mm/26.93 ± 3.88 mm, respectively. The horizontal angle between IOFs/SOFs and the medial/lateral canthi are 72.54 ± 7.13 degrees, 66.77 ± 5.17 degrees, 47.45 ± 6.57 degrees, 54.69 ± 8.38 degrees, respectively. Based on the hard tissues, The SOF localized 20.55 ± 3.24 mm medial and 13.78 ± 2.60 mm superior to the zygomaticofrontal suture. And the horizontal angle between them is 56.04 ± 6.87 degrees. The IOF localized 18.52 ± 2.30 mm medial and 30.79 ± 3.29 inferior to the zygomaticofrontal suture. The horizontal angle between them is 31.06 ± 4.33 degrees. We also found that most (96.81%) of the IOFs were located below the middle line of the zygomatic arch. These results may provide more detailed information about the locations of SOF and IOF. And they will facilitate prediction of the locations of IOF and SOF in clinical procedure.

Location of mental foramen based on soft- and hard-tissue landmarks in a chinese population.

The purpose of the present study was to determine the location of the mental foramen (MF) based on soft- and hard-tissue landmarks, to facilitate prediction of the location of this structure during facial and dental surgery. Forty-two hemispheres of 21 adult cadavers (16 men and 5 women; aged 30-75 years) were dissected to expose the MF. The locations of the MFs were evaluated with direct and photographic measurements. Most of the MFs presented a single foramen (95%), except for only 2 cases with double foramina (5%). The MFs localized 23.38 +/- 2.00 mm inferior and 3.55 +/- 1.70 mm medial to the cheilion in the front view while 23.59 +/- 2.11 mm inferior and 7.19 +/- 3.03 mm posterior to the cheilion in the lateral view. Based on the hard-tissue landmarks, we found that most of the MFs localized inferior the second premolar in most of the cases (73.8%), and the MFs localized 23.34 +/- 2.39 mm below the cusp tip of the second premolar, 16.56 +/- 2.53 mm below the inferior alveoli, and 15.56 +/- 1.74 mm superior the bottom of the mandible. The position of the MF varied from 8.7 degrees medial to 15.5 degrees posterior in the vertical angle with the change of surgical body position from supine to lay-side position. Our results may provide a more detailed information to predict the location of the MFs.

Temporal dynamic changes of connexin 43 expression in C6 cells following lipopolysaccharide stimulation.

Connexin 43, a gap junction protein, is expressed mainly in glia in the central nervous system. Neuroinflammation plays an important role in central nervous system injury. Changes to glial connexin 43 levels and neuroinflammation may trigger brain injury and neurodegenerative diseases. To illustrate the relationship between connexin 43 and neuroinflammation, this study investigated how connexin 43 expression levels change in lipopolysaccharide-stimulated rat C6 glioma cells. C6 cells were treated with 0.05, 0.25, 0.5, 1, 2.5 and 5 µg/mL lipopolysaccharide for 24 hours. The nitrite estimation-detected nitric oxide release level was elevated substantially after lipopolysaccharide stimulation. To test the transcriptional level changes of inducible nitric oxide synthase, tumor necrosis factor-α and connexin 43 mRNA, C6 cells were treated with 5 µg/mL lipopolysaccharide for 3-48 hours. Reverse transcription-PCR showed that the expression of inducible nitric oxide synthase and tumor necrosis factor-α mRNA increased over time, but connexin 43 mRNA levels increased in lipopolysaccharide-stimulated C6 cells at 3 and 6 hours, and then decreased from 12 to 48 hours. Connexin 43 protein expression was detected by immunofluorescence staining, and the protein levels matched the mRNA expression levels. These results suggest that connexin 43 expression is biphasic in lipopolysaccharide-induced neuroinflammation in C6 cells, which may be correlated with the connexin 43 compensatory mechanism.