Extended Transsphenoidal Microsurgical Approach for Diaphragma Sellae and Tuberculum Meningiomas

Abstract OBJECTIVE To evaluate the anatomic aspects of the diaphragma sellae and its potential role in directing the growth of a pituitary adenoma. METHODS Twenty cadaveric heads were dissected and measurements were taken at the level of the diaphragma sellae. RESULTS The diaphragma sellae is composed of two layers of dura mater. There is a remarkable variation in the morphology of the diaphragm opening. The average anteroposterior distance of the opening was 7.26 mm (range, 3.4–10.7 mm) and the average lateral-to-lateral distance was 7.33 mm (range, 2.8–14.1 mm). CONCLUSION The variability in the diameter of the opening of the diaphragma sellae could explain the growth of pituitary tumors toward the cavernous sinus or toward the suprasellar region.

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Suprasellar meningiomas: the effect of tumor location on postoperative visual outcome

Journal of Neurosurgery ◽

10.3171/jns.1988.69.4.0523 ◽

1988 ◽

Vol 69 (4) ◽

pp. 523-528 ◽

Cited By ~ 120

Author(s):

Brian T. Andrews ◽

Charles B. Wilson

Keyword(s):

Visual Loss ◽

Visual Outcome ◽

Tumor Location ◽

Postoperative Recovery ◽

Optic Canal ◽

Visual Disability ◽

Content Type ◽

Tuberculum Sellae ◽

Diaphragma Sellae ◽

Planum Sphenoidale

✓ The authors reviewed 38 cases of suprasellar meningioma to determine the correlation between tumor site and postoperative visual outcome. Progressive visual loss, the most frequent initial complaint (94.7%), occurred over a mean of 24½ months, was most often unilateral (18 patients) or bilateral but asymmetrical (14 patients), and was severe (20/200 vision or worse) in 23 patients; 24 patients had visual field abnormalities. Computerized tomography or magnetic resonance studies clearly delineated the lesions but did not appear to permit earlier diagnosis. Eleven patients had tumors limited to the tuberculum sellae; the tumor extended from the tuberculum sellae onto the planum sphenoidale in nine patients, into one optic canal in eight, onto the diaphragma sellae in seven, and onto the medial sphenoid wing in three. Patients with tumors affecting the optic canal had severe unilateral visual loss more often than those with tumors at other sites. Tumors limited to the tuberculum sellae were most often completely resected; postoperative recovery of vision was also most frequent in patients with tumors at this site. Tumors involving the diaphragma sellae or the medial sphenoid wing were least often completely removed and most likely to be associated with postoperative visual deterioration. Overall, 42% of patients had improved vision postoperatively, 30% remained unchanged, and 28% were worse. After a mean follow-up period of 38 months, 24 patients are doing well, four have significant visual disability, and three are blind or doing poorly. Two patients died of causes unrelated to their tumor. Three patients have had tumor recurrence.

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Transtemporal Bone Microsurgical Approach to Acoustic Neuromas

Archives of Otolaryngology - Head and Neck Surgery ◽

10.1001/archotol.1965.00760010097003 ◽

1965 ◽

Vol 82 (2) ◽

pp. 95-95

Author(s):

G. E. SHAMBAUGH

Keyword(s):

Acoustic Neuromas ◽

Microsurgical Approach

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Stereotactic localization and open microsurgical approach in the treatment of some intracranial deep arteriovenous malformations

Surgical Neurology ◽

10.1016/0090-3019(86)90178-3 ◽

1986 ◽

Vol 25 (6) ◽

pp. 535-539 ◽

Cited By ~ 4

Author(s):

Rafael Carrillo ◽

Rafael Garcia de Sola ◽

Maximino Gonzalez-Ojellón ◽

José Garcia-Uria ◽

Gonzalo Bravo

Keyword(s):

Arteriovenous Malformations ◽

Stereotactic Localization ◽

Microsurgical Approach

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Varicocele surgery or embolization: Which is better?

Canadian Urological Association Journal ◽

10.5489/cuaj.295 ◽

2013 ◽

Vol 6 (4) ◽

pp. 266 ◽

Cited By ~ 19

Author(s):

Darby Cassidy ◽

Keith Jarvi ◽

Ethan Grober ◽

Kirk Lo

Keyword(s):

Failure Rate ◽

Attractive Alternative ◽

Published Data ◽

Technical Failure ◽

Failure Rates ◽

Male Factor Infertility ◽

Male Factor ◽

Gonadal Vein ◽

Microsurgical Approach ◽

The Right

Introduction: Varicocele remains the most commonly identifiedcorrectable cause of male factor infertility. Surgical correction isthe most commonly performed technique to treat varicoceles with a technical failure rate of less than 5%. An attractive alternative to surgery is the selective catheterization and embolization of the gonadal vein. This data are limited by small series.Methods: We reviewed a total of 158 patients. These patientsunderwent embolization for clinical varicoceles and male factorinfertility between 2004 and 2008. Of these, 56% underwentattempted bilateral embolization, 43% unilateral left-sided embolization and 1.3% unilateral right-sided embolization.Results: Of these patients who underwent attempted bilateralembolization, 19.3% did not experience a successful obliterationof the right gonadal vein and 2.3% (2/88) experienced a failure rate in the embolization of the left gonadal vein. Of the 2 attempts at unilateral right-sided embolization, there were no failures. Of the 68 unilateral left-sided embolization attempts, there was a 4.4% failure rate. Of all of the right-sided embolization attempts, 18.9% failed, while 3.2% of the left-sided attempts failed.Conclusion: This review represents the largest contemporary series of varicocele embolization outcomes currently in the literature. Our 19.3% technical failure rate for bilateral varicocele embolization is higher than the current published rate of 13% and is largely related to failure to successfully occlude the right gonadal vein. This supports our belief that bilateral varicoceles are best managed with a primary microsurgical approach, where technical failure rates are expected to be less than 5% based on published data. Men withunilateral left-sided varicoceles should be offered both options as they have similar failure rates, but with embolization offering some clear advantages to the patient.

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Diagnosis and microsurgical approach to far-lateral disc herniation in the lumbar spine

Journal of Neurosurgery ◽

10.3171/jns.1990.72.3.0378 ◽

1990 ◽

Vol 72 (3) ◽

pp. 378-382 ◽

Cited By ~ 92

Author(s):

Joseph C. Maroon ◽

Thomas A. Kopitnik ◽

Larry A. Schulhof ◽

Adnan Abla ◽

James E. Wilberger

Keyword(s):

Facet Joint ◽

Lumbar Disc ◽

Spinal Nerve ◽

Magnetic Resonance Images ◽

Content Type ◽

Enhanced Ct ◽

Disc Herniations ◽

Microsurgical Approach ◽

Far Lateral ◽

Fine Print

✓ Lumbar-disc herniations that occur beneath or far lateral to the intervertebral facet joint are increasingly recognized as a cause of spinal nerve root compression syndromes at the upper lumbar levels. Failure to diagnose and precisely localize these herniations can lead to unsuccessful surgical exploration or exploration of the incorrect interspace. If these herniations are diagnosed, they often cannot be adequately exposed through the typical midline hemilaminectomy approach. Many authors have advocated a partial or complete unilateral facetectomy to expose these herniations, which can lead to vertebral instability or contribute to continued postoperative back pain. The authors present a series of 25 patients who were diagnosed as having far lateral lumbar disc herniations and underwent paramedian microsurgical lumbar-disc excision. Twelve of these were at the L4–5 level, six at the L5–S1 level, and seven at the L3–4 level. In these cases, myelography is uniformly normal and high-quality magnetic resonance images may not be helpful. High-resolution computerized tomography (CT) appears to be the best study, but even this may be negative unless enhanced by performing CT-discography. Discography with enhanced CT is ideally suited to precisely diagnose and localize these far-lateral herniations. The paramedian muscle splitting microsurgical approach was found to be the most direct and favorable anatomical route to herniations lateral to the neural foramen. With this approach, there is no facet destruction and postoperative pain is minimal. Patients were typically discharged on the 3rd or 4th postoperative day. The clinical and radiographic characteristics of far-lateral lumbar-disc herniations are reviewed and the paramedian microsurgical approach is discussed.

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Fetal nondopaminergic neural implants in parkinsonian primates

Journal of Neurosurgery ◽

10.3171/jns.1991.74.1.0097 ◽

1991 ◽

Vol 74 (1) ◽

pp. 97-104 ◽

Cited By ~ 88

Author(s):

Krzysztof S. Bankiewicz ◽

Robert J. Plunkett ◽

David M. Jacobowitz ◽

Irwin J. Kopin ◽

Edward H. Oldfield

Keyword(s):

Dopaminergic Neurons ◽

Neural Implants ◽

Behavioral Recovery ◽

Foramen Of Monro ◽

Caudate Nuclei ◽

Content Type ◽

Primate Brain ◽

Brain Implants ◽

Microsurgical Approach ◽

Fine Print

✓ Implantation of fetal dopamine-containing tissue into preformed cavities in the caudate nucleus of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced parkinsonian monkeys leads to behavioral recovery. Recovery may be related to two sources of dopamine: the grafted cells and/or the sprouted fibers from host dopaminergic neurons. The authors undertook this study to determine whether behavioral recovery requires release of dopamine by the implanted tissue, and to establish if nondopaminergic fetal central nervous system implants can induce sprouting of dopamine fibers in the primate brain and cause behavioral recovery. Rhesus monkeys with MPTP-induced hemiparkinsonism or full parkinsonism and a stable neurological deficit were used for this study. Cavities were created in the caudate nuclei anterior to the foramen of Monro via an open microsurgical approach. Fetal cerebellum or spinal cord was implanted into the preformed cavities of three monkeys. Control parkinsonian monkeys showed no recovery. However, implant-induced improvement was stable for up to 6 months after implantation. Sprouted dopaminergic fibers oriented from the ventral striatum and nucleus accumbens were found in the area of the tissue implant in the animals that received fetal grafts but were not present in the control monkeys. It is concluded that brain implants do not need to contain dopamine to induce functional recovery in MPTP-induced parkinsonian primates. Implant-induced and trophic factor-mediated dopaminergic sprouting by the host brain plays a role in the behavioral recovery and may well be responsible for the clinical improvement seen in parkinsonian patients after brain implants.

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