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Medial wall of the cavernous sinus: microanatomical diaphanoscopic and episcopic investigation

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Abstract

Purpose

To elucidate the question whether expansion of pituitary adenomas into the cavernous sinus (CS) has to be regarded as focal penetration rather than invasion, a microanatomical study of the medial wall (MW) of the CS was performed.

Method

Fourteen sellar hemiblocks underwent microsurgical dissection from lateral and medial approach. The thickness of the MW of the CS was examined by diaphanoscopy.

Findings

The internal carotid artery (ICA) was adherent to the MW in five cases. In five specimens the lateral wall of the sella turcica consisted of a single layer without perforations. In nine cases this wall had two layers. There was no perforation of both layers in any case. Diaphanoscopy revealed thin MW in the lateral border of the sella (n = 13), below the horizontal segment of the ICA (n = 10), and antero-inferiorly to the carotid syphon (n = 9).

Conclusions

Expansion into the CS may be facilitated by low anatomical resistance against chronic tumor growth.

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Authors and Affiliations

  1. Department of Neurosurgery, Johannes Wesling Klinikum, Hans-Nolte-Str. 1, 32429, Minden, Germany

    Ulrich J. Knappe

  2. Institute of Anatomy, Johannes-Gutenberg-Universität, Mainz, Germany

    Moritz A. Konerding

  3. Department of Neurosurgery, Dr.-Horst-Schmidt-Klinik, Wiesbaden, Germany

    Robert Schoenmayr

Authors
  1. Ulrich J. Knappe
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  2. Moritz A. Konerding
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  3. Robert Schoenmayr
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Corresponding author

Correspondence to Ulrich J. Knappe.

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Comment

The authors present an interesting paper that addresses the clinical problem of invasion of the cavernous sinus by pathological processes, specifically pituitary tumors. They elegantly demonstrate the microanatomy of the medial wall of the cavernous sinus and, in so doing, help readers to better understand the anatomical reasons that explain how these tumors can grow into the cavernous sinus.

Mario Zuccarello

Mayfield Clinic, Cincinnati, OH

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Knappe, U.J., Konerding, M.A. & Schoenmayr, R. Medial wall of the cavernous sinus: microanatomical diaphanoscopic and episcopic investigation. Acta Neurochir 151, 961–967 (2009). https://doi.org/10.1007/s00701-009-0340-3

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  • DOI: https://doi.org/10.1007/s00701-009-0340-3

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