Cysts ; Humans ; Paranasal Sinus Diseases ; surgery ; Sphenoid Bone ; Sphenoid Sinus ; surgery

OBJECTIVEThe anatomic features of transsphenoidal approach are reviewed, focusing on the microsurgical anatomy of suprasellar and parasellar structures. Pertinent microsurgical anatomy is described for neurosurgeons to successfully extend a standard transsphenoidal approach for treatment of lesions including the region of the tuberculum sellae, planum sphenoidale, supradiaphragmatic intradural space, and medial cavernous sinus.

METHODS15 specimens (30 sides) from formalin fixed cadaveric heads and 20 adult dry skulls (40 sides) were observed. According to the need for the extend transsphenoidal approach, the sellar and parasellar region: the planum sphenoidale and the supradiaphragmatic area, medial part of cavernous sinus were studied. Special emphases were put on the relation of the cranial nerve and blood vessel structures surrounding the sellar. Meanwhile, we made the cast specimen of the blood vessel and studied the structure character of the internal carotid artery in the cavernous sinus.

RESULTSPosterior ethmoidal could be exit as para or suprasphenoidal ethmoidal air cell. It will be important for extending the transsphenoidal approach. The mean distance between two optic canal is 15.7 +/- 3.2 mm (11.0 - 18.0 mm), the distance of internal carotid artery at tuberculum cellae level is 13.9 +/- 3.8 mm (10.0 - 17.0 mm), the mean distance between tuberculum cellae and the posterior rim of cribriform plate is 23.3 +/- 3.2 mm, the included angle between sagittal plane and optic canal is 36.3 degrees +/- 1.6 degrees , with the anatomy research data give the clue that the bone window should be made as the shape of "[see text]".

CONCLUSIONSExpending transsphenoidal approach is suitable for medium and small lesions growing along the centre line which expand to para sellar, anterior sellar and sphenoid platform. That hypophysis has close relation with internal carotid artery during expending transsphenoidal approach to cavernous sinus increase the risk of operation. The carotid artery and abducent nerve are the easiest structures to be damaged during the operation.

Adult ; Cadaver ; Cavernous Sinus ; anatomy & histology ; surgery ; Humans ; Sphenoid Bone ; anatomy & histology ; surgery ; Sphenoid Sinus ; anatomy & histology ; surgery

Fibrous dysplasia is a bone disease of unknown etiology in which cellular fibrous tissue gradually replaces normal bone and involves the cranium infrequently. Recently, we have experienced 3 cases of fibrous dysplasia which involved the frontal, sphenoid and parietal bones with vault deformity. The 2 cases, in which the frontal and sphenoid bones were involved, presented with proptosis and exophthalmos. All of the cases manifested vault deformity which caused cosmetic problems. We performed decompressive and plastic surgery for the purpose of relieving the compression of cranial nerves and for the sake of the cosmetic effect. The clinical courses were uneventful.
Bone Diseases ; Congenital Abnormalities ; Cranial Nerves ; Exophthalmos ; Parietal Bone ; Skull ; Sphenoid Bone ; Surgery, Plastic

OBJECTIVETo report the results of endoscopic transpterygoid intervention of nine patients with meningoencephalocele and cerebrospinal fluid (CSF) leaks within lateral recess of sphenoid sinus (LRSS). The diagnosis, operative techniques and their related problems were discussed.

METHODSNine hospitalized patients with meningoencephalocele and CSF leaks within lateral recess of sphenoid sinus (LRSS) were included in this paper. Six were male and 3 were female, aged from 27 to 56 years old. Two patients had the histories of endoscopic repair. The preoperative orientation of CSF leaks and meningoencephalocele depended on CT scan and MR cisternography. Endoscopic transpterygoid intervention and the repair of skull base defects were undertaken under general anesthesia.

RESULTSAll the operations were successful. One patient had a postoperative intracranial hypertension and Hydrocephalus. Two patients had postoperative ipsilateral facial, upper lip and palatal hypesthesia. One of them had a xerophthalmia. All the symptoms above mentioned relieved gradually 6 months after operation. No recurrence was found during follow -up for 6 to 58 months (mean 25. 6 months).

CONCLUSIONSEndoscopic transpterygoid intervention for meningoencephalocele and CSF leaks within LRSS is a minimally invasive technique and a straightforward approach.

Adult ; Cerebrospinal Fluid Rhinorrhea ; complications ; surgery ; Endoscopy ; methods ; Female ; Humans ; Male ; Meningocele ; complications ; surgery ; Middle Aged ; Skull Base ; surgery ; Sphenoid Bone ; surgery ; Sphenoid Sinus ; Treatment Outcome

This paper reported one patient who was treated through transphenoidal-upslope approach by lateral rhinotomy and the tumor was successfully removed. The patient was male of 38 years old. He suffered intermittent headache with blurred vision and left eye outreach disorder for more than a year. The visual inspection showed there was dark area of the left eye lateral. CT showed slopes density placeholder and bone window showed the slope of bone quality had been severely damaged. MRI showed T1 image slopes parts and other low signal placeholder forward to invade the sphenoid sinus. In addition, there was undermine the slope bone and brain stem boundaries clearly and T2 images showed high-signal, inhomogeneous enhancement. We found during the operation that the slope was partially destroyed and part of the tumor was prominent to the pharynx tumor. The pathologic examination confirmed that it is chordoma.
Adult ; Chordoma ; surgery ; Cranial Fossa, Posterior ; surgery ; Humans ; Male ; Microsurgery ; methods ; Skull Base Neoplasms ; surgery ; Sphenoid Bone ; surgery

Objective: To evaluate the value of Hadad-Bassagasteguy flap (HBF) in endoscopic endonasal approaches (EEA) skull base reconstruction by radioanatomic measurements on CT of the skull base of Chinese adults. The following data in terms of anterior skull base defect and reconstruction, sphenoid platform area and middle skull base defect and reconstruction including sphenoid platform and sella area, clivus area defect and reconstruction, and HBF were collected and assessed. Methods: CT image data of 42 Chinese adults were selected to obtain radioanatomic measurement data related to HBF, anterior skull base defect and reconstruction, middle skull base defect and reconstruction, and defect and reconstruction of clivus area. SPSS 26.0 software was used to analyze the data. Results: The radioanatomic measurement data about HBF and skull base of 42 Chinese adults were obtained. The width of the leading edge of HBF [(37.49±2.86) mm] was 6 mm more than the anterior skull base width at the level of the anterior ethmoidal artery [(30.87±8.61) mm], and the width of the trailing edge of HBF [(42.61±3.95) mm] was also 6 mm more than the anterior skull base width at the level of the sphenoethmoidal junction [(26.79±2.79) mm]. The total length of HBF including the pedicle [(79.68±4.96) mm] was 6 mm more than the length of the anterior skull base reconstruction [(54.06±8.67) mm], and the length of HBF without pedicle [(46.27±3.14)] mm was 6 mm more than the length of anterior skull base defect [(30.87±8.61) mm]. The trailing edge width was 6 mm more than the planum sphenoidal width at the level of the optic strut [(30.87±8.61) mm]. The total length of HBF including the pedicle was 6 mm more than the length of the planum sphenoidal, and the sella reconstruction [(64.44±10.25) mm], also was 6 mm more than the length of the planum sphenoidal reconstruction [(73.61±8.28) mm]. The length of HBF without pedicle was 6 mm more than the length of the planum sphenoidal, and the sella defect [(27.88±3.74) mm], also was 6 mm more than the length of the planum sphenoidal defect [(15.50±3.38) mm]. The width of the leading edge of HBF and the width of the trailing edge were both 6 mm more than the width of clivus reconstruction at the level of the foramen lacerum [(21.68±2.30) mm]. The total length of HBF including pedicles was 6 mm more than the clivus reconstruction length [(67.09±5.44) mm], while the length of HBF without pedicles was also 6 mm more than the clivus defect length [(37.19±3.80) mm]. Conclusions: In this study, the radiosanatomic measurements ensured that HBF could provide sufficient tissue flap for the reconstruction of the anterior skull base and sphenoid plateau and extend the reconstruction area to sella and clivus. Preoperative radiosanatomic measurement can be used to predict the size of HBF required for skull base reconstruction, which provides important guidance for flap harvest.
Adult ; Endoscopy ; Humans ; Nose/surgery* ; Reconstructive Surgical Procedures ; Skull Base/surgery* ; Skull Base Neoplasms/surgery* ; Sphenoid Bone ; Surgical Flaps

OBJECTIVE: To investigate the diagnosis and treatment of fibrous dysplasia (FD) involving the skull base. METHOD: The clinical data of 15 patients with fibrous dysplasia involving the skull base was retrospective analysis. RESULT: All patients were underwent CT examinations. FD involved orbital roof in 15 patients, ethmoidal bone in 15 patients, middle and lower nasal turbinate in 8 patients, frontal bone in 8 patients, sphenoidal bone in 6 patients, and maxillary bone in a patient. Although the optic canal was affected in 4 patients, only one patient had impaired vision. All the patients were treated by craniofacial approach. One patient with impaired vision was performed decompression of optic canal and had improved in vision. The titanium mesh was use for construction of skull base defect. There were not complications, such as infection, cerebral hemorrhage, etc. CONCLUSION It should be underwent surgical treatment for fibrous dysplasia involving skull base which resulted in clinical manifestations. Whether prophylactic decompression of optic canal is performed or notr depends on the patients clinical and radiological information.
Adolescent ; Adult ; Female ; Fibrous Dysplasia of Bone ; pathology ; surgery ; Frontal Bone ; pathology ; Humans ; Male ; Maxilla ; pathology ; Orbit ; surgery ; Retrospective Studies ; Skull Base ; pathology ; Sphenoid Bone ; pathology ; Young Adult

OBJECTIVETo study the clinical value of the whole-course endoscopic extended transsphenoidal approach assisted by neuronavigation in surgical resection of complex sphenoclival lesions.

METHODSImage reconstruction and registration were performed for 15 patients with complex sphenoclival lesions using the neuronavigation system, and the bilateral nasal extended transsphenoidal approach was adopted to remove the lesions with a whole-course endoscopic procedure.

RESULTSPostoperative pathological examination reported pituitary adenomas in 7 cases, chordomas in 5 cases, and cavernous angiomas in 3 cases. Total removal of the lesions was achieved in 10 cases, subtotal removal in 4 cases, and partial removal in 1 case. Transient polyuria occurred in 3 cases and 2 patients experienced temporary cerebrospinal rhinorrhea. No death occurred in these cases after the operation. During the follow-up ranging from 3 to 26 months, only 2 patients with partial lesion removal showed recurrence and received subsequent radiotherapy.

CONCLUSIONThe combination of whole-course endoscopic technique and neuronavigation can help improve the surgical outcomes and reduce complications of complex sphenoclival lesion removal via the extended transsphenoidal approach.

Adult ; Aged ; Chordoma ; surgery ; Female ; Humans ; Male ; Middle Aged ; Neuroendoscopy ; Neuronavigation ; Pituitary Neoplasms ; surgery ; Skull Base Neoplasms ; surgery ; Sphenoid Bone ; pathology ; surgery

OBJECTIVETo investigate the clinical applied anatomy in the region of anterior clinoid process, and to improve the therapeutic efficacy of clinoidal tumors.

METHODSTwelve patients with large meningiomas located in clinoid were surgically treated via the extended anterior and middle fossa combined with epidural approach between January 1998 and August 2004. The surgical outcome and follow-up results were reviewed retrospectively. Supraorbital-posterional approach and cranioorbital zygomatic approach were used when tumors involved cavernous sinus. Anterior clinoid process was grinded with high-speed drilling. Supply of tumors were blocked extradurally. Tumors were resected intradurally.

RESULTSOf the 12 cases in large meningiomas located in clinoid, 8 cases had total removal of tumors, 3 patients had subtotal removal. Of the 10 patients with pre-operative severe visual deterioration, 6 patients was markedly improved, one patient unchanged and one patient worsened post-operatively. No death was found in this group.

CONCLUSIONSUsing epidural approach for clinoidal meningiomas and grinding anterior clinoid process was advantageous to block tumors base blood supply and detach infraclinoidal tumors from internal carotid artery. Supraorbital-pterional approach could minimize brain retraction and was advantageous to expose superior pole of giant tumors.

Adult ; Female ; Humans ; Male ; Meningeal Neoplasms ; pathology ; surgery ; Meningioma ; pathology ; surgery ; Middle Aged ; Neurosurgical Procedures ; methods ; Retrospective Studies ; Sphenoid Bone ; surgery ; Treatment Outcome

OBJECTIVETo retrospectively investigate the effectiveness of sphenzygomatic suture as a guide in the reduction of zygomatic complex fracture.

METHODS55 cases of zygomatic complex fracture classified according to Zingg classification were treated, sphenozygomatic suture in group 1 (n = 36) was reduced first, then the other fracture line was reduced, in group 2 (n = 19), malar bone was reduced according to superficial fracture line. Patients were followed up for 4 weeks to 3 months, aesthetic result and X-ray symmetry were observed.

RESULTSAll patients in group 1 were restored with satisfactory facial contour, 35 cases got precise reduction, 5 cases in group 2 were asymmetry.

CONCLUSIONDuring open reduction of complex zygomatic fracture, sphenozygomatic suture should be reduced at first as a guide, so as to get precise zygomatic complex reconstruction and normal aesthetic outcome.

Adolescent ; Adult ; Cranial Sutures ; Female ; Follow-Up Studies ; Fracture Fixation ; methods ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Sphenoid Bone ; surgery ; Zygoma ; surgery ; Zygomatic Fractures ; surgery