scholarly journals Intraoperative Doppler ultrasound of the cavernous part of the internal carotid artery in endoscopic transsphenoidal removal of the laterosellar tumors

2019 ◽  
Vol 21 (1) ◽  
pp. 27-34
Author(s):  
O. I. Sharipov ◽  
D. V. Fomichev ◽  
M. A. Kutin ◽  
P. L. Kalinin
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Doppler Ultrasound ◽  
Cavernous Sinus ◽  
Dura Mater ◽  
Pituitary Adenomas ◽  
Internal Carotid ◽  
Blue Color ◽  
Study Objective ◽  
Invasive Method

The study objective is to describe the technique of intraoperative Doppler ultrasound (DU) of brain arteries and to determine the indications for its use during endoscopic transsphenoidal operations. Materials and methods. The study included 100 patients with skull base tumors (pituitary adenomas, trigeminal schwannomas, chordomas), operated via standard or extended transsphenoid endoscopic approaches. For DU, the location of the internal carotid artery (ICA) relative to the surface of the tumor or dura mater was determined as a red and/or blue color of the monitor screen in the M-mode window, accompanied by a characteristic sound signal. Results. DU was used to remove pituitary adenomas in 95 cases, trigeminal schwannomas in 3 cases, chordomas in 2 cases. Intraoperative DU helped to locate the ICA during removal of the laterosellar part of the tumor in all observations. In none of the cases presented were no injuries to the ICA. Сonclusion. DU is an effective and non-invasive method for detecting ICA during endoscopic operations which contributes to the safe disposal of laterosellar tumors. Adequate use of the method does not carry well-known and potential risks. DU should be performed when the tumor is removed from the cavernous sinus or its projection via the lateral extended transsphenoidal endoscopic access (to determine the safe boundaries of the dura mater section in the cavernous sinus projection). 

scholarly journals Ultrasound Doppler examination in the surgical treatment of pituitary adenomas with cavernous sinus extension

2021 ◽  
Vol 27 (1) ◽  
pp. 29-33
Author(s):  
Ruslan V. Aksyonov ◽  
Orest I. Palamar ◽  
Andrii P. Huk ◽  
Dmytro I. Okonskyi ◽  
Dmytro S. Teslenko
Keyword(s):  
Surgical Treatment ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Doppler Ultrasound ◽  
Cavernous Sinus ◽  
Pituitary Adenomas ◽  
Internal Carotid ◽  
Gross Total Resection ◽  
Total Resection ◽  
Endoscopic Endonasal

Objective: To determine the effectiveness of intraoperative Doppler ultrasound in the surgical treatment of pituitary adenomas with invasive parasellar growth into the cavernous sinus Knosp 3 and Knosp 4. Material and Methods. During 2009–2017, 71 patients with pituitary adenomas (PA) with extension into the cavernous sinus Knosp 3 and Knosp 4 were retrospectively reviewed. According to the size PA were divided into pituitary macroadenomas, (from 10 to 40 mm) in 45 (63.4%) patients, and giant PA (over 40 mm) – in 26 (36.6%) patients. Cavernous sinus invasion Knosp 3 and 4 was identified in 47 (66.2%) and 24 (33.8%) patients respectively. Non-secreting PA - 43 (60.5%) patients and hormone-secreting PA - 28 patients (39.4%). Endoscopic endonasal trassphenoidal (EET) approach was used in all cases. Laterally expanded EET (LEEET) approach was used in 29 cases. Intraoperative Doppler ultrasound (IDUS) was used in 36 (51%) cases. Results. Intraoperative Doppler ultrasound was used in cases of Knosp 3 extension in 23 (32.4%) cases and in Knosp 4 - in 13 (18.3%) cases. Gross total resection, including extension into the cavernous sinus using IDUS was achieved in 22 (62.7%) patients. In cases where IDUS was not used, gross total resection was achieved in 19 (52.7%) cases. In cases where the IDUS was not used, recurrence rate was 7.3%, with IDUS - 5%. Biochemical remission was achieved in 22 (78.6%) cases. Liquorrhea nasalis after surgery was observed in 6 (8.4%) cases, meningoencephalitis - in 1 (1.4%) case, oculomotor palsy -3 (4.2%) cases. Conclusions. Intraoperative Doppler ultrasound is an informative method that provides safe resection of pituitary adenomas with cavernous sinus extension with a low level of possible postoperative complications. Parasellar extension of Pituitary adenomas into the cavernous sinus Knosp 4 significantly reduces the possibility of gross total resection. However, the use of intraoperative ultrasound makes it possible to determine safe boundaries for manipulation both medially and laterally from the internal carotid artery, increasing the level of radicality and the duration of clinical remission. Intraoperative Doppler ultrasound during endoscopic endonasal transsphenoidal surgery of pituitary adenomas with parasellar extension allows to identify the internal carotid artery in the tumor stroma with the existing changed skull base anatomy. Dura incision under intraoperative Doppler ultrasound reduces the risk of internal carotid artery injury.

Stab Wounds to the Temporal Fossa

Neurosurgery ◽  
1988 ◽  
Vol 23 (4) ◽  
pp. 431-435 ◽  
Author(s):  
C. S. Haworth ◽  
J. C. de Villiers
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Dura Mater ◽  
Basilar Artery ◽  
Internal Carotid ◽  
Stab Wound ◽  
Temporal Fossa ◽  
Stab Wounds ◽  
Prognostic Features

Abstract Stab wounds to the temporal fossa appear as a characteristic clinical entity. Patients admitted with stab wounds to the head during the period 1970 to 1986 were reviewed retrospectively. Of these, 10 met the criteria of having suffered a stab wound that penetrated the skull and dura mater of the temporal fossa. Injury to the internal carotid artery-cavernous sinus complex (3 patients) or to the basilar artery-pons region (5 patients) was frequent. Two other patients experienced injury to the trigeminal nerve and the petrous ridge. The mechanical, neurological, radiological, and prognostic features of knife wounds to this region are discussed.

Tumors Invading the Cavernous Sinus That Cause Internal Carotid Artery Compression Are Rarely Pituitary Adenomas

2011 ◽  
pp. P1-435-P1-435
Author(s):  
Mark E Molitch ◽  
Laura Cowen ◽  
Raymond Stadiem ◽  
Alexander Uihlein ◽  
Michelle Naidich ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Pituitary Adenomas ◽  
Internal Carotid ◽  
Carotid Artery Compression

Tumors invading the cavernous sinus that cause internal carotid artery compression are rarely pituitary adenomas

Pituitary ◽  
2012 ◽  
Vol 15 (4) ◽  
pp. 598-600 ◽  
Author(s):  
Mark E. Molitch ◽  
Laura Cowen ◽  
Raymond Stadiem ◽  
Alexander Uihlein ◽  
Michelle Naidich ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Pituitary Adenomas ◽  
Internal Carotid ◽  
Carotid Artery Compression

scholarly journals Dural architecture of cavernous sinus. Structural Solid Marrow of the Sellyar Region

2020 ◽  
pp. 10-32
Author(s):  
R. N. Lyunkova
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Dura Mater ◽  
Internal Carotid ◽  
Cranial Nerves ◽  
Vascular Neurosurgery ◽  
Base Of The Skull ◽  
The Brain

Surgery of the base of the skull requires knowledge of the topography of the internal carotid artery, cavernous sinus, cranial nerves of the sellyar and paraclinoid regions. Equally important is knowledge of the topography and structure of the dura mater (CSF) at the base of the skull, CSF duplicates, cerebellar ligaments, meningeal membranes (tank membranes of the brain base, carotid oculomotor membrane of the proximal carotid ring) and carotid rings in neurooncology and vascular neurosurgery. The article presents the results of the study of the structure of TMO in the selvary and paraselar regions.

scholarly journals Rare Clinical Onset of Nontraumatic Intracavernous Aneurysm of the Internal Carotid Artery: A Diagnostic and Therapeutic Challenge

2020 ◽  
Author(s):  
Enzo Emanuelli ◽  
Maria Baldovin ◽  
Claudia Zanotti ◽  
Sara Munari ◽  
Luca Denaro ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Arterial Injury ◽  
Sphenoidal Sinus ◽  
Therapeutic Challenge ◽  
Cavernous Sinus Syndrome ◽  
Sellar Lesions ◽  
Risk Of Rupture

AbstractWhile the so-called pseudoaneurysms can result from arterial injury during trans-sphenoidal surgery or after a trauma, spontaneous aneurysms of cavernous–internal carotid artery (CICA) are rare. Symptoms vary and the differential diagnosis with other, more frequent, sellar lesions is difficult. We describe three cases of misdiagnosed CICA spontaneous aneurysm. In two cases the onset was with neuro-ophthalmological manifestations, classifiable as “cavernous sinus syndrome.” The emergency computed tomography scan did not show CICA aneurysm and the diagnosis was made by surgical exploration. The third patient came to our attention with a sudden severe unilateral epistaxis; endonasal surgery revealed also in this case a CICA aneurysm, eroding the wall and protruding into the sphenoidal sinus. When the onset was with a cavernous sinus syndrome, misdiagnosis exposed two patients to potential serious risk of bleeding, while the patient with epistaxis was treated with embolization, using coils and two balloons. Intracavernous nontraumatic aneurysms are both a diagnostic and therapeutic challenge, because of their heterogeneous onset and risk of rupture, potentially lethal. Intracavernous aneurysms can be managed with radiological follow-up, if asymptomatic or clinically stable, or can be surgically treated with endovascular or microsurgical techniques.

scholarly journals Internal Carotid Artery Injury in Transsphenoidal Surgery: Tenets for Its Avoidance and Refit—A Clinical Study

2021 ◽  
Vol 11 (1) ◽  
pp. 99
Author(s):  
Dmitry Usachev ◽  
Oleg Sharipov ◽  
Ashraf Abdali ◽  
Sergei Yakovlev ◽  
Vasiliy Lukshin ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Transsphenoidal Surgery ◽  
Internal Carotid ◽  
Treatment Options ◽  
Carotid Artery Injury ◽  
Anatomical Features ◽  
Stent Grafting ◽  
Internal Carotid Artery Injury

One of the most serious/potentially fatal complications of transsphenoidal surgery (TSS) is internal carotid artery (ICA) injury. Of 6230 patients who underwent TSS, ICA injury occurred in 8 (0.12%). The etiology, possible treatment options, and avoidance of ICA injury were analyzed. ICA injury occurred at two different stages: (1) during the exposure of the sella floor and dural incision over the sella and cavernous sinus and (2) during the resection of the cavernous sinus extension of the tumor. The angiographic collateral blood supply was categorized as good, sufficient, and nonsufficient to help with the decision making for repairing the injury. ICA occlusion with a balloon was performed at the injury site in two cases, microcoils in two patients, microcoils plus a single barrel extra-intracranial high-flow bypass in one case, stent grafting in one case, and no intervention in two cases. The risk of ICA injury diminishes with better preoperative preparation, intraoperative navigation, and ultrasound dopplerography. Reconstructive surgery for closing the defect and restoring the blood flow to the artery should be assessed depending on the site of the injury and the anatomical features of the ICA.

The So-Called Cavernous Sinus: A Review of the Controversy and Its Implications for Neurosurgeons

Neurosurgery ◽  
1982 ◽  
Vol 11 (5) ◽  
pp. 712-717 ◽  
Author(s):  
John N. Taptas
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Cranial Nerves ◽  
Sella Turcica ◽  
Middle Cranial Fossa ◽  
Cranial Fossa ◽  
Base Of The Skull ◽  
Extradural Space

Abstract The so-called cavernous sinus is a venous pathway, an irregular network of veins that is part of the extradural venous network of the base of the skull, not a trabeculated venous channel. This venous pathway, the internal carotid artery, and the oculomotor cranial nerves cross the medial portion of the middle cranial fossa in an extradural space formed on each side of the sella turcica by the diverging aspects of a dural fold. In this space the venous pathway has only neighborhood relations with the internal carotid artery and the cranial nerves. The space itself must be distinguished from the vascular and nervous elements that it contains. The revision of the anatomy of this region has not only theoretical interest but also important clinical implications.

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