Comparison of Intradural, Interdural, and Extradural Pituitary Transposition Techniques for Accessing Lesions Involving the Upper Clivus, Retroinfundibular Area, and Interpeduncular Cistern

2019 ◽  
Author(s):  
Kumar Abhinav ◽  
Carol Yan ◽  
Matthew Tyler ◽  
Zara Patel ◽  
Peter Hwang ◽  
...  
Keyword(s):  
Interpeduncular Cistern

Surgery for angiographically occult cerebral aneurysms

1993 ◽  
Vol 79 (5) ◽  
pp. 674-679 ◽  
Author(s):  
Jafar J. Jafar ◽  
Howard L. Weiner
Keyword(s):  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Sylvian Fissure ◽  
Ct Scans ◽  
Anterior Communicating Artery ◽  
Content Type ◽  
Excellent Outcome ◽  
Interpeduncular Cistern ◽  
Spontaneous Subarachnoid Hemorrhage ◽  
Exploratory Surgery

✓ In 15% of patients with spontaneous subarachnoid hemorrhage (SAH), the source of bleeding cannot be determined despite repeated cerebral angiography. However, some patients diagnosed as having “SAH of unknown cause” actually harbor undetected aneurysms. The authors report six patients with SAH who, despite multiple negative cerebral angiograms, underwent exploratory surgery due to a high clinical and radiographic suspicion for the presence of an aneurysm. Brain computerized tomography (CT) scans revealed blood located mainly in the basal frontal interhemispheric fissure in four patients, in the sylvian fissure in one patient, and in the interpeduncular cistern in one patient. The patients were evaluated as Hunt and Hess Grades I to III, and had undergone at least two high-quality cerebral angiograms that did not reveal an aneurysm. Vasospasm was visualized in two patients. Three patients rebled while in the hospital. Exploratory surgery was performed at an average of 12 days post-SAH. Five aneurysms were discovered at surgery and were successfully clipped. All four patients with interhemispheric blood were found to have an anterior communicating artery (ACoA) aneurysm. The patient with blood in the sylvian fissure was found to have a middle cerebral artery aneurysm. These aneurysms were partially thrombosed. No aneurysm was detected in the patient with interpeduncular SAH, despite extensive basilar artery exploration. Five patients had an excellent outcome and one patient developed diabetes insipidus. These results show that exploratory aneurysm surgery is warranted, despite repeated negative cerebral angiograms, if the patient manifests the classical signs of SAH with CT scans localizing blood to a specific cerebral blood vessel (particularly the ACoA) and if a second SAH is documented at the same site.

scholarly journals Mapping Solute Clearance From the Mouse Hippocampus Using a 3D Imaging Cryomicrotome

2021 ◽  
Vol 15 ◽  
Author(s):  
Daphne M. P. Naessens ◽  
Johannes G. G. Dobbe ◽  
Judith de Vos ◽  
Ed VanBavel ◽  
Erik N. T. P. Bakker
Keyword(s):  
Brain Structures ◽  
Small Subset ◽  
Protein Accumulation ◽  
Waste Products ◽  
Molecular Weights ◽  
Interpeduncular Cistern ◽  
Subarachnoid Spaces ◽  
The Brain ◽  
Infusion Period ◽  
Solute Clearance

The hippocampus is susceptible to protein aggregation in neurodegenerative diseases such as Alzheimer’s disease. This protein accumulation is partially attributed to an impaired clearance; however, the removal pathways for fluids and waste products are not fully understood. The aim of this study was therefore to map the clearance pathways from the mouse brain. A mixture of two fluorescently labeled tracers with different molecular weights was infused into the hippocampus. A small subset of mice (n = 3) was sacrificed directly after an infusion period of 10 min to determine dispersion of the tracer due to the infusion, while another group was sacrificed after spreading of the tracers for an additional 80 min (n = 7). Upon sacrifice, mice were frozen and sectioned as a whole by the use of a custom-built automated imaging cryomicrotome. Detailed 3D reconstructions were created to map the tracer spreading. We observed that tracers distributed over the hippocampus and entered adjacent brain structures, such as the cortex and cerebroventricular system. An important clearance pathway was found along the ventral part of the hippocampus and its bordering interpeduncular cistern. From there, tracers left the brain via the subarachnoid spaces in the directions of both the nose and the spinal cord. Although both tracers followed the same route, the small tracer distributed further, implying a major role for diffusion in addition to convection. Taken together, these results reveal an important clearance pathway of solutes from the hippocampus.

Microsurgery for Upper Basilar Tip Aneurysm With Intraoperative Rupture: 3-Dimensional Operative Video

2018 ◽  
Vol 16 (2) ◽  
pp. E43-E43 ◽  
Author(s):  
Oliver Soto Granados ◽  
Marcos Devanir Silva da Costa ◽  
Bruno Lourenço Costa ◽  
Kléber González-Echeverría ◽  
Samantha Lorena Paganelli ◽  
...  
Keyword(s):  
Young Patients ◽  
3 Dimensional ◽  
Microsurgical Treatment ◽  
Fluid Analysis ◽  
Interpeduncular Cistern ◽  
Orbitozygomatic Approach ◽  
Aneurysm Occlusion ◽  
Aneurysm Dissection ◽  
Intraoperative Rupture ◽  
Spontaneous Subarachnoid Hemorrhage

Abstract In the last years, a shift from the microsurgical treatment to an endovascular therapy in patients with basilar apex aneurysm has been settled, part of this phenomenon is related to the significant tendency of vital perforators to be involved in the aneurysm dissection and clipping, which can implicate unfavorable outcomes. Nevertheless, microsurgical treatment remains the treatment that can provide the superior rates of stable and durable aneurysm occlusion, which is most important to young patients. In this video, we present the case of a 45-yr-old female patient who complained of a sudden and severe headache and presented with progressive lethargy during the following 3 d. At admission, computed tomography did not show abnormal findings. However, cerebrospinal fluid analysis showed erythrocytes and corroborated the clinical suspicion of spontaneous subarachnoid hemorrhage. The patient signed the Institutional Consent Form, which allows the use of his/her images and videos for any type of medical publications in conferences and/or scientific articles. Angiography and magnetic resonance imaging revealed a saccular basilar apex aneurysm. It showed a wide neck as well as a lobulated dome with upward and slightly left projection. The aneurysm did not involve angiographically visible thalamoperforator arteries, which allowed the microsurgical treatment by the fronto-orbitozygomatic approach. However, during the interpeduncular cistern dissection, an intraoperative rupture of the aneurysm occurred. This video exemplifies the steps required to manage an intraoperative rupture of a basilar apex aneurysm.

scholarly journals Delayed Pneumocephalus-Induced Cranial Neuropathy

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Neena I. Marupudi ◽  
Monika Mittal ◽  
Sandeep Mittal
Keyword(s):  
Cranial Nerve ◽  
Nerve Palsy ◽  
Oculomotor Nerve ◽  
Nerve Compression ◽  
Neurological Deficits ◽  
Oculomotor Nerve Palsy ◽  
Cranial Neuropathy ◽  
Cranial Nerve Deficit ◽  
Moderate Amount ◽  
Interpeduncular Cistern

Pneumocephalus is a common occurrence after cranial surgery, with patients typically remaining asymptomatic from a moderate amount of intracranial air. Postsurgical pneumocephalus rarely causes focal neurological deficits; furthermore, cranial neuropathy from postsurgical pneumocephalus is exceedingly uncommon. Only 3 cases have been previously reported that describe direct cranial nerve compression from intracranial air resulting in an isolated single cranial nerve deficit. The authors present a patient who developed dysconjugate eye movements from bilateral oculomotor nerve palsy. Direct cranial nerve compression occurred as a result of postoperative pneumocephalus in the interpeduncular cistern. The isolated cranial neuropathy gradually recovered as the intracranial air was reabsorbed.

Primary intracranial hydatid cyst in the interpeduncular cistern

2005 ◽  
Vol 147 (7) ◽  
pp. 781-783 ◽  
Author(s):  
E. Beskonakli ◽  
I. Solaroglu ◽  
K. Tun ◽  
L. Albayrak
Keyword(s):  
Hydatid Cyst ◽  
Interpeduncular Cistern ◽  
Intracranial Hydatid Cyst

Zygomaticotemporal Approach to the Basis Cranii and Basilar Artery

Neurosurgery ◽  
1988 ◽  
Vol 23 (1) ◽  
pp. 20-22 ◽  
Author(s):  
Glenn Neil-Dwyer ◽  
Michael Sharr ◽  
Richard Haskell ◽  
David Currie ◽  
Massoud Hosseini
Keyword(s):  
Temporal Lobe ◽  
Basilar Artery ◽  
Masseter Muscle ◽  
Anterior Approach ◽  
Zygomatic Bone ◽  
Interpeduncular Cistern ◽  
Suprasellar Region ◽  
Brain Retraction

ABSTRACT When using the zygomaticotemporal approach, one removes the whole of the zygomatic bone with its attachment to the masseter muscle, allowing a lower and more anterior approach to the interpeduncular cistern along the inferomedial surface of the temporal lobe. Minimal brain retraction is required to give an excellent view of the bifurcation of the basilar artery and of the suprasellar region. (Neurosurgery 23:20-22, 1988)

scholarly journals Zygomatic Anterior Subtemporal Approach for Lesions in the Interpeduncular Cistern

Skull Base ◽  
2001 ◽  
Vol 11 (04) ◽  
pp. 257-264 ◽  
Author(s):  
Haluk Deda ◽  
Hasan Çaglar Ugur
Keyword(s):  
Subtemporal Approach ◽  
Interpeduncular Cistern

Microsurgical Anatomy of the Cisternal Course of the Perforating Branches of the Posterior Communicating Artery

Neurosurgery ◽  
1990 ◽  
Vol 26 (5) ◽  
pp. 824-831 ◽  
Author(s):  
F. Vincentelli ◽  
G. Caruso ◽  
F. Grisoli ◽  
P. Rabehanta ◽  
C. Andriamamonjy ◽  
...  
Keyword(s):  
Close Relationships ◽  
Oculomotor Nerve ◽  
Posterior Communicating Artery ◽  
Microsurgical Anatomy ◽  
Embryological Development ◽  
Interpeduncular Cistern ◽  
Anatomical Arrangement ◽  
Human Brains

Abstract Both the perforating branches-especially the extracerebral segments-and the arachnoidal anatomy at the level of the posterior communicating artery were studied in 60 human brains previously fixed in formalin. The close relationships between this artery and the oculomotor nerve are described, and it is noted that each of them is enclosed in its own arachnoidal compartment, which in the case of the posterior communicating artery is to be distinguished from the interpeduncular cistern. The latter cistern was found to contain only the terminal segments of the posterior communicating artery. The hypothalamic branches were within the inner wall of the arachnoidal cistern surrounding the posterior communicating artery. The variations in diameter of this artery are explained by its embryological development and are not related to the number and the diameter of the perforators. The posterior communicating artery was absent at times. The surgical implications of such a variable anatomical arrangement are discussed in the light of the literature.

Ectopic pituitary adenoma occurring in the interpeduncular cistern

1995 ◽  
Vol 83 (6) ◽  
pp. 1092-1094 ◽  
Author(s):  
Tetsuya Takahata ◽  
Yoichi Katayama ◽  
Takashi Tsubokawa ◽  
Hideki Oshima ◽  
Atsuo Yoshino
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Stalk ◽  
Surgical Removal ◽  
Pars Tuberalis ◽  
Pituitary Cells ◽  
Content Type ◽  
Ectopic Pituitary Adenoma ◽  
Interpeduncular Cistern ◽  
Suprasellar Cistern ◽  
Endocrine Symptoms

✓ Intracranial ectopic pituitary adenoma occurs most frequently in the suprasellar cistern, usually in continuity with the pituitary stalk. Such tumors probably originate from cells of the pars tuberalis located above the diaphragma sellae or from aberrant anterior pituitary cells of the pituitary stalk. The authors report the case of a 37-year-old woman with Cushing's syndrome caused by an ectopic pituitary adenoma of unique location: the tumor was separate from the pituitary stalk and confined within the interpeduncular cistern. After surgical removal of the tumor, continued improvement in the patient's laboratory results and disappearance of her endocrine symptoms strongly indicated the absence of adenoma cells in the pituitary gland or stalk. The tumor in the present case appears to have arisen from aberrant pituitary cells that were present in the leptomeninges of the basal surface of the hypothalamus.

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