Endonasal endoscopic cadaveric dissection of sellar-suprasellar region and cavernous sinus - a descriptive and morphometric study

Endoscopic skull base surgery has evolved in recent years from technological advancement in medical equipment related especially to the field of optical technology. The paradigm shift that occurred with the introduction of the modem rigid rod lens endoscope into the neurosurgical armamentarium sa...

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Main Author:	Sheng, Gee Teak
Format:	Thesis
Language:	English
Published:	2011
Subjects:	RD520-599.5 Surgery by region system or organ
Online Access:	http://eprints.usm.my/57620/1/DR%20GEE%20TEAK%20SHENG%20MD%20%28UPM%29%20-%20e.pdf
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id	my-usm-ep.57620
record_format	uketd_dc
institution	Universiti Sains Malaysia
collection	USM Institutional Repository
language	English
topic	RD520-599.5 Surgery by region system or organ
spellingShingle	RD520-599.5 Surgery by region system or organ Sheng, Gee Teak Endonasal endoscopic cadaveric dissection of sellar-suprasellar region and cavernous sinus - a descriptive and morphometric study
description	Endoscopic skull base surgery has evolved in recent years from technological advancement in medical equipment related especially to the field of optical technology. The paradigm shift that occurred with the introduction of the modem rigid rod lens endoscope into the neurosurgical armamentarium saw the exponential expansion of the role of its use in pituitary tumor and endonasal skull base surgery. Due to the distinct differences between microscope and endoscope optic principles, it is important that familiarity with endonasal endoscopic anatomical landmarks be recognized by the young trainee surgeon in neurosurgery. A morphometric study of the relevant anatomy of endonasal approaches to the sellar and parasellar region is crucial to gain understanding of the anatomy of this region. Three asian human cadaveric heads underwent staged endonasal endoscopic dissections and anatomical landmark images were captured and morphometric measurements were attempted. Twenty Paranasal Sinus Protocol Computer Tomography of patients undergoing studies for suspected sinus disease and 20 Pituitary protocol Magnetic Resonance Imaging studies of patients being investigated for suspected pituitary diseases were selected for morphometric measurements. On the Paranasal Sinus Protocol Computer Tomography, the coronal surface area of middle and inferior chonchal bone, the whole turbinate and the meatus were measured using Osirix software. On the coronal CT imaging the vidian canal- foramen rotundum distance were measured with Osirix software. On the Pituitary MRI the maximal anterior sphenoidal width, naso-vomer distance, chiasmal width and height, infundibulum distance, inter-carotid distance, sphenoid septum numbers, position, height and projection towards paraclival and parasellar ICA prominence, suprasellar cistern volume, pituitary area and computed volume were measured with Osirix software. On staged endonasal endoscopic cadaveric dissections; the middle turbinate, posterior choana and the sphenoid ostium were identified during the nasal and sphenoid phase. Identification of sella floor with adjacent clivus, optic and carotid protuberances and the optico-carotid recesses were documented during the sellar phase. The suprasellar and parasellar phase, the arteries identifiable were the ICA, ACA, MCA, PCom, basilar artery, PCA, superior cerebellar, and AICA. The cranial nerves Ill, IV, V and VI were identified. The pituitary gland with its stalk, posterior in relation to the optic chiasm was noted. Mamillary bodies and anterior floor of third ventricle were identified and opening was made in its floor to gain access into the third ventricle. The foramen of Monroe with its choroid plexus, the massa intermedia, and the superior medullary velum could be visualized with the 3 mm endoscope for intraventricular exploration. On the paranasal sinus CT images, the inferior chonchal mean area at anterior, middle and posterior coronal levels were 0.13, 0.24 and 0.14 cm2 on the left side and 0.15, 0.27 and 0.16 cm2 on the right side. The whole inferior turbinate mean area at anterior, middle and posterior coronal level were 1.10, 1.39 and 1.19 cm2 on left side and 1.02, 1.36 and 1.14 cm2 on right side. Majority of inferior meatus area on all levels and both sides were more than 0.20 cm2 • The inferior meatus area is smallest at its anterior coronal level (mean of 0.38 cm2 on both side) and widest at the mid coronal level (right 0.79 cm2 and left 0.75 cm2). The mean middle chonchal area at vertical, oblique and horizontal coronal levels were 0.19, 0.12 and 0.20 cm2 on the left side and 0.21, 0. 14 and 0.14 cm2 on the right side. The mean of whole middle turbinate area at vertical, oblique and horizontal coronal levels were 0.52, 0.41 and 0.47 cm2 on the left side and 0.55, 0.46 and 0.49 cm2 on the right side. Majority of the middle meatus studied demonstrated a surface area of more than 0.20 cm2 and none of the concha, whole turbinate and meatus areas was significantly different when comparison were made for gender group as well as among the age groups. The mean vidian canal-foramen rotundum distance was 5.5 mm on right side and 5.3 mm on left side. On the Pituitary protocol MRI, the mean maximal anterior sphenoidal width was 2.92 cm, naso-vomer distance 3.98 cm, chiasma width 1.48 cm, chiasma height 0.21 cm, infundibular height 0.61 cm, inter-carotid distance 1.69 cm, right, middle and left sphenoid septum heights were 1.31, 1. 7 4, 1.27 cm respectively. Computed suprasellar cistern and pituitary volume were 1.83 and 0.44 cm3 respectively. Forty-five percent of sphenoid septums were in close proximity to the ICA prominence, with 75% of right sphenoid septum and 64% of left sphenoid septum pointed towards the ICA prominence. Understanding the endonasal endoscopic anatomy of the sellar, suprasellar and cavernous sinus region augmented by morphometric measurements of relevant landmarks is important to improve the accuracy of the endonasal endoscopic trajectory to the midline and extended transsphenoidal approaches and this would translates into a 'safe road map' during surgery.
format	Thesis
qualification_level	Master's degree
author	Sheng, Gee Teak
author_facet	Sheng, Gee Teak
author_sort	Sheng, Gee Teak
title	Endonasal endoscopic cadaveric dissection of sellar-suprasellar region and cavernous sinus - a descriptive and morphometric study
title_short	Endonasal endoscopic cadaveric dissection of sellar-suprasellar region and cavernous sinus - a descriptive and morphometric study
title_full	Endonasal endoscopic cadaveric dissection of sellar-suprasellar region and cavernous sinus - a descriptive and morphometric study
title_fullStr	Endonasal endoscopic cadaveric dissection of sellar-suprasellar region and cavernous sinus - a descriptive and morphometric study
title_full_unstemmed	Endonasal endoscopic cadaveric dissection of sellar-suprasellar region and cavernous sinus - a descriptive and morphometric study
title_sort	endonasal endoscopic cadaveric dissection of sellar-suprasellar region and cavernous sinus - a descriptive and morphometric study
granting_institution	Universiti Sains Malaysia
granting_department	Pusat Pengajian Sains Perubatan
publishDate	2011
url	http://eprints.usm.my/57620/1/DR%20GEE%20TEAK%20SHENG%20MD%20%28UPM%29%20-%20e.pdf
_version_	1776101203596279808
spelling	my-usm-ep.576202023-03-29T04:02:20Z Endonasal endoscopic cadaveric dissection of sellar-suprasellar region and cavernous sinus - a descriptive and morphometric study 2011 Sheng, Gee Teak RD520-599.5 Surgery by region, system, or organ Endoscopic skull base surgery has evolved in recent years from technological advancement in medical equipment related especially to the field of optical technology. The paradigm shift that occurred with the introduction of the modem rigid rod lens endoscope into the neurosurgical armamentarium saw the exponential expansion of the role of its use in pituitary tumor and endonasal skull base surgery. Due to the distinct differences between microscope and endoscope optic principles, it is important that familiarity with endonasal endoscopic anatomical landmarks be recognized by the young trainee surgeon in neurosurgery. A morphometric study of the relevant anatomy of endonasal approaches to the sellar and parasellar region is crucial to gain understanding of the anatomy of this region. Three asian human cadaveric heads underwent staged endonasal endoscopic dissections and anatomical landmark images were captured and morphometric measurements were attempted. Twenty Paranasal Sinus Protocol Computer Tomography of patients undergoing studies for suspected sinus disease and 20 Pituitary protocol Magnetic Resonance Imaging studies of patients being investigated for suspected pituitary diseases were selected for morphometric measurements. On the Paranasal Sinus Protocol Computer Tomography, the coronal surface area of middle and inferior chonchal bone, the whole turbinate and the meatus were measured using Osirix software. On the coronal CT imaging the vidian canal- foramen rotundum distance were measured with Osirix software. On the Pituitary MRI the maximal anterior sphenoidal width, naso-vomer distance, chiasmal width and height, infundibulum distance, inter-carotid distance, sphenoid septum numbers, position, height and projection towards paraclival and parasellar ICA prominence, suprasellar cistern volume, pituitary area and computed volume were measured with Osirix software. On staged endonasal endoscopic cadaveric dissections; the middle turbinate, posterior choana and the sphenoid ostium were identified during the nasal and sphenoid phase. Identification of sella floor with adjacent clivus, optic and carotid protuberances and the optico-carotid recesses were documented during the sellar phase. The suprasellar and parasellar phase, the arteries identifiable were the ICA, ACA, MCA, PCom, basilar artery, PCA, superior cerebellar, and AICA. The cranial nerves Ill, IV, V and VI were identified. The pituitary gland with its stalk, posterior in relation to the optic chiasm was noted. Mamillary bodies and anterior floor of third ventricle were identified and opening was made in its floor to gain access into the third ventricle. The foramen of Monroe with its choroid plexus, the massa intermedia, and the superior medullary velum could be visualized with the 3 mm endoscope for intraventricular exploration. On the paranasal sinus CT images, the inferior chonchal mean area at anterior, middle and posterior coronal levels were 0.13, 0.24 and 0.14 cm2 on the left side and 0.15, 0.27 and 0.16 cm2 on the right side. The whole inferior turbinate mean area at anterior, middle and posterior coronal level were 1.10, 1.39 and 1.19 cm2 on left side and 1.02, 1.36 and 1.14 cm2 on right side. Majority of inferior meatus area on all levels and both sides were more than 0.20 cm2 • The inferior meatus area is smallest at its anterior coronal level (mean of 0.38 cm2 on both side) and widest at the mid coronal level (right 0.79 cm2 and left 0.75 cm2). The mean middle chonchal area at vertical, oblique and horizontal coronal levels were 0.19, 0.12 and 0.20 cm2 on the left side and 0.21, 0. 14 and 0.14 cm2 on the right side. The mean of whole middle turbinate area at vertical, oblique and horizontal coronal levels were 0.52, 0.41 and 0.47 cm2 on the left side and 0.55, 0.46 and 0.49 cm2 on the right side. Majority of the middle meatus studied demonstrated a surface area of more than 0.20 cm2 and none of the concha, whole turbinate and meatus areas was significantly different when comparison were made for gender group as well as among the age groups. The mean vidian canal-foramen rotundum distance was 5.5 mm on right side and 5.3 mm on left side. On the Pituitary protocol MRI, the mean maximal anterior sphenoidal width was 2.92 cm, naso-vomer distance 3.98 cm, chiasma width 1.48 cm, chiasma height 0.21 cm, infundibular height 0.61 cm, inter-carotid distance 1.69 cm, right, middle and left sphenoid septum heights were 1.31, 1. 7 4, 1.27 cm respectively. Computed suprasellar cistern and pituitary volume were 1.83 and 0.44 cm3 respectively. Forty-five percent of sphenoid septums were in close proximity to the ICA prominence, with 75% of right sphenoid septum and 64% of left sphenoid septum pointed towards the ICA prominence. Understanding the endonasal endoscopic anatomy of the sellar, suprasellar and cavernous sinus region augmented by morphometric measurements of relevant landmarks is important to improve the accuracy of the endonasal endoscopic trajectory to the midline and extended transsphenoidal approaches and this would translates into a 'safe road map' during surgery. 2011 Thesis http://eprints.usm.my/57620/ http://eprints.usm.my/57620/1/DR%20GEE%20TEAK%20SHENG%20MD%20%28UPM%29%20-%20e.pdf application/pdf en public masters Universiti Sains Malaysia Pusat Pengajian Sains Perubatan

Endonasal endoscopic cadaveric dissection of sellar-suprasellar region and cavernous sinus - a descriptive and morphometric study

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