Skip to main content

Advertisement

SpringerLink
Log in

The diaphragma sellae, diaphragm opening, and subdiaphragmatic cistern: an anatomical study using magnetic resonance imaging

  • Original Article
  • Published:
Surgical and Radiologic Anatomy Aims and scope Submit manuscript

Abstract

Purpose

Few studies have explored the detailed morphology of the diaphragma sellae (DS), diaphragm opening (DO) or stoma, and subdiaphragmatic cistern (SDC) using neuroimages. The aim of the present study was to characterize these structures using magnetic resonance imaging.

Methods

Thin-sliced, sagittal and coronal T2-weighted imaging was performed for a total of 84 outpatients.

Results

The DS, DO, SDC, and relevant structures were consistently delineated in all patients. In 66% of patients, all three structures appeared to be highly variable, and were classifiable as six distinct morphological types. In 4% of patients, the DS presented as a complete sheet lacking a discernible DO. In addition, 30% of the patients presented with undiscernible SDCs. In the coronal sections of 11% of patients, the pituitary glands extended laterally, reaching or extending beyond the center line on the sectional image of the cavernous internal carotid artery.

Conclusions

Thin-sliced, sagittal, and coronal T2-weighted sequences are useful for delineating the DS, DO, and SDC. Morphological variation of these structures among individuals may considerably influence the direction of pituitary tumor expansion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Abuzayed B, Tanriöver N, Ozlen F, Gazioğlu N, Ulu MO, Eraslan B, Akar Z (2009) Endoscopic endonasal transsphenoidal approach to the sellar region. Results of endoscopic dissection on 30 cadavers. Turk Neurosurg 19:237–244

    PubMed  Google Scholar 

  2. Campero A, Martins C, Yasuda A, Rhoton AL Jr (2008) Microsurgical anatomy of the diaphragma sellae and its role in direction the pattern of growth of pituitary adenomas. Neurosurgery 62:717–723

    Article  PubMed  Google Scholar 

  3. Cebula H, Kurbanov A, Zimmer LA, Poczos P, Leach JL, De Battista JC, Froelich S, Theodosopoulos PV, Keller JT (2014) Endoscopic endonasal variability in the anatomy of the internal carotid artery. World Neurosurg 82:e759–e764

    Article  PubMed  Google Scholar 

  4. Cho KH, Rodríguez-Vázquez JF, Han EH, Verdugo-López S, Murakami G, Cho BH (2010) Human primitive meninges in and around the mesencephalic flexure and particularly their topographical relation to cranial nerves. Ann Anat 192:322–328

    Article  PubMed  Google Scholar 

  5. Ciappetta P, Pescatori L (2017) Anatomic dissection of arachnoid membranes encircling the pituitary stalk on fresh, non-formalin-fixed specimens: anatomoradiologic correlations and clinical applications in craniopharyngioma surgery. World Neurosurg 108:479–490

    Article  PubMed  Google Scholar 

  6. Daniels DL, Pojunas KW, Kilgore DP, Pech P, Meyer GA, Williams AL, Haughton VM (1986) MR of the diaphragms sellae. AJNR Am J Neuroradiol 7:765–769

    CAS  PubMed  Google Scholar 

  7. Destrieux C, Kakou MK, Velut S, Lefrancq T, Jan M (1998) Microanatomy of the hypophyseal fossa boundaries. J Neurosurg 88:743–752

    Article  CAS  PubMed  Google Scholar 

  8. Di leva A, Tschabitscher M, Matula C, Komatsu F, Komatsu M, Colombo G, Sherif C, Galzio RJ (2012) The subdiaphragmatic cistern: historic and radioanatomic findings. Acta Neurochir (Wien) 154:667–674

    Article  Google Scholar 

  9. Doraiswamy PM, Potts JM, Axelson DA, Husain MM, Lurie SN, Na C, Eacalona PR, McDonald WM, Figiel GS, Ellinwood EH Jr et al (1992) MR assessment of pituitary gland morphology in healthy volunteers: age- and gender-related differences. AJNR Am J Neuroradiol 13:1295–1299

    CAS  PubMed  Google Scholar 

  10. Ferreri AJ, Garrido SA, Markarian MG, Yañez A (1992) Relationship between the development of diaphragma sellae and morphology of the sella turcica and its content. Surg Radiol Anat 14:233–239

    Article  CAS  PubMed  Google Scholar 

  11. Guinto Balanzar G, Abdo M, Mercado M, Guinto P, Nishimura E, Arechiga N (2011) Diaphragma sellae: a surgical reference for transsphenoidal resection of pituitary macroadenomas. World Neurosurg 75:286–293

    Article  PubMed  Google Scholar 

  12. Guitelman M, Garcia Basavilbaso N, Vitale M, Chervin A, Katz D, Miragaya K, Herrera J, Cornalo D, Servidio M, Boero L, Manavela M, Danilowicz K, Alfieri A, Stalldecker G, Glerean M, Fainstein Day P, Ballarino C, Mallea Gil MS, Rogozinski A (2013) Primary empty sella (PES): a review of 175 cases. Pituitary 16:270–274

    Article  CAS  PubMed  Google Scholar 

  13. Gulsen S, Dinc AH, Unal M, Cantürk N, Altinors N (2010) Characterization of the anatomic location of the pituitary stalk and its relationship to the dorsum sellae, tuberculum sellae and chiasmatic cistern. J Korean Neurosurg Soc 47:169–173

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ju KS, Bae HG, Park HK, Chang JC, Choi SK, Sim KB (2010) Morphometric study of the Korean adult pituitary glands and the diaphragma sellae. J Korean Neurosurg Soc 47:42–47

    Article  PubMed  PubMed Central  Google Scholar 

  15. Knosp E, Steiner E, Kitz K, Matula C (1993) Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery 33:610–618

    CAS  PubMed  Google Scholar 

  16. Kursat E, Yilmazlar S, Aker S, Aksoy K, Oyguch H (2008) Comparison of lateral and superior walls of the pituitary fossa with clinical emphasis on pituitary adenoma extension: cadaveric-anatomic study. Neurosurg Rev 31:91–98

    Article  PubMed  Google Scholar 

  17. Lee KF, Parke W, Lin SR, Choi HY, Schatz NJ (1978) The vasculature of the diaphragma sellae. A postmortem injection study. Neuroradiology 16:281–283

    Article  CAS  PubMed  Google Scholar 

  18. Nomura M, Tachibana O, Yamashima T, Yamashita J, Suzuki M (2002) MRI evaluation of the diaphragmal opening: using MRI parallel to the transsphenoidal surgical approach. J Clin Neurosci 9:175–177

    Article  CAS  PubMed  Google Scholar 

  19. Renn WH, Rhoton AL Jr (1975) Microsurgical anatomy of the sellar region. J Neurosurg 43:288–298

    Article  CAS  PubMed  Google Scholar 

  20. Sage MR, Blumbergs PC, Fowler GW (1982) The diaphragma sellae: its relationship to normal sellar variations in frontal radiographic projections. Radiology 145:699–701

    Article  CAS  PubMed  Google Scholar 

  21. Sage MR, Blumbergs PC, Mulligan BP, Fowler GW (1982) The diaphragma sellae: its relationship to the configuration of the pituitary gland. Radiology 145:703–708

    Article  CAS  PubMed  Google Scholar 

  22. Thines L, Lee SK, Dehdashti AR, Agid R, Willinsky RA, Wallace CM, Terbrugge KG (2009) Direct imaging of the distal dural ring and paraclinoid internal carotid artery aneurysms with high-resolution T2 turbo-spin echo technique at 3-T magnetic resonance imaging. Neurosurgery 64:1059–1064

    Article  PubMed  Google Scholar 

  23. Tsunoda A, Okuda O, Sato K (1997) HR height of the pituitary gland as a function of age and sex: especially physiological hypertrophy in adolescence and in climacterium. AJNR Am J Neuroradiol 81:914–920

    Google Scholar 

  24. Umansky F, Valarezo A, Elidan J (1994) The superior wall of the cavernous sinus: a microanatomical study. J Neurosurg 81:914–920

    Article  CAS  PubMed  Google Scholar 

  25. Won HS, Han SH, Oh CS, Lee JI, Chung IH, Kim SH (2010) Topographic variations of the optic chiasm and the foramen diaphragma sellae. Surg Radiol Anat 32:653–657

    Article  PubMed  Google Scholar 

  26. Yohannan DG, Krishnapillai R, Suresh R, Ramnarayan S (2015) A morphometric study of diaphragma sellae and delineation of its relation to optic neural pathways through computer aided superimposition. Anat Res Int 618042

Download references

Acknowledgements

This work was not supported by grant funding.

Author information

Authors and Affiliations

  1. Department of Neurological Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, 279-0021, Chiba, Japan

    Satoshi Tsutsumi, Yukimasa Yasumoto & Hisato Ishii

  2. Division of Radiological Technology, Medical Satellite Yaesu Clinic, Tokyo, Japan

    Hideo Ono

Authors
  1. Satoshi Tsutsumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hideo Ono
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yukimasa Yasumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hisato Ishii
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Satoshi Tsutsumi developed the study design. Hisato Ishii and Yukimasa Yasumoto collected the imaging data. Hideo Ono and Hisato Ishii analyzed the imaging data. Satoshi Tsutsumi wrote the manuscript.

Corresponding author

Correspondence to Satoshi Tsutsumi.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest concerning the materials or methods used in this study, or the findings presented in this paper.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tsutsumi, S., Ono, H., Yasumoto, Y. et al. The diaphragma sellae, diaphragm opening, and subdiaphragmatic cistern: an anatomical study using magnetic resonance imaging. Surg Radiol Anat 41, 529–534 (2019). https://doi.org/10.1007/s00276-019-02184-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00276-019-02184-0

Keywords

Search

Navigation