Microsurgical anatomy of the inferior intercavernous sinus

Surg Radiol Anat. 2021 Feb;43(2):211-218. doi: 10.1007/s00276-020-02581-w. Epub 2020 Sep 25.

Abstract

Purpose: Intercavernous sinuses (ICSs) are physiological communications between the cavernous sinuses. The ICSs run between the endosteal and meningeal layers of the dura mater of the sella turcica. Whereas the anterior and posterior ICSs have been frequently described, the inferior ICS (iICS) has been less well studied in the literature; however, poor awareness of the ICS's anatomy can lead to serious problems during transsphenoidal, transsellar surgery. The objective of the present anatomical study was to describe the iICS in detail.

Methods: The study was carried out over a 6-month period in a university hospital's anatomy laboratory, using brains extracted from human cadavers. The brains were injected with colored neoprene latex and dissected to study the iICS (presence or absence, shape, diameter, length, distance between inferior and anterior ICSs, distance between inferior and posterior ICSs, relationships, and boundaries).

Results: Seventeen cadaveric specimens were studied, and an iICS was found in all cases (100%). The shape was variously plexiform (47.1%), filiform (35.3%), or punctiform (17.6%). The mean ± standard deviation diameter and length of the iICS were 3.75 ± 2.90 mm and 11.92 ± 2.96 mm, respectively. The mean iICS-anterior ICS and iICS-posterior ICS distances were 5.36 ± 1.99 mm and 7.03 ± 2.28 mm, respectively.

Conclusion: The iICS has been poorly described in the literature. However, damage to the iICS during transsphenoidal, transsellar surgery could lead to serious vascular complications. A precise radiological assessment appears to be essential for a safe surgical approach.

Keywords: Inferior intercavernous sinus; Pituitary adenoma; Pituitary gland; Sella turcica; Transsphenoidal surgery.

Publication types

  • Case Reports

MeSH terms

  • Adenoma / diagnosis
  • Adenoma / pathology
  • Adenoma / surgery*
  • Adult
  • Blood Loss, Surgical / prevention & control*
  • Cadaver
  • Cavernous Sinus / anatomy & histology*
  • Cavernous Sinus / diagnostic imaging
  • Cavernous Sinus / surgery
  • Female
  • Humans
  • Hypophysectomy / adverse effects
  • Hypophysectomy / methods
  • Magnetic Resonance Imaging
  • Microsurgery / adverse effects
  • Microsurgery / methods
  • Natural Orifice Endoscopic Surgery / adverse effects
  • Natural Orifice Endoscopic Surgery / methods
  • Pituitary Gland / diagnostic imaging
  • Pituitary Gland / pathology
  • Pituitary Gland / surgery
  • Pituitary Neoplasms / diagnosis
  • Pituitary Neoplasms / pathology
  • Pituitary Neoplasms / surgery*
  • Sella Turcica / anatomy & histology*
  • Sella Turcica / diagnostic imaging
  • Sella Turcica / surgery