Navdar DOĞUŞ UZUN, Gökşin Nilüfer YONGUÇ, Mehmet Ozan DURMAZ, Hamit Selim KARABEKİR, Nüket GÖÇMEN-MAS

Morphometric Analysis of Hypophyseal Fosa Related Structure; in Terms of Surgical Aproach

INTRODUCTION: The importance of knowledge regarding both the anatomy and the structures of the skull base are cited in many neurosurgery and radiology papers. Therefore, the purposes of our study were to identify the surgical corridors and to determine the mean distances to help establish the safest distances for surgical approaches. METHODS: We examined 16 dry human skulls of unknown gender that belonged to the Anatomy Department Laboratory of Dokuz Eylul University Medical School. Foramen lacerum (FL), foramen rotundum (FL), foramen ovale (FO), hypophyseal fossa, anterior clinoid process (ACP) and posterior clinoid process (PCP) were determined in all skull bases and distances between these parameters were recorded with digital Vernier caliper which was accurate to millimeters. RESULTS: The FR’s distance to the ACP on the right side was greater than on the left side ( p: 0.41). The FO’s distance to the PCP on the left side was greater than on the right side (p: 0.010). There were no other statistically significant differences between the left and right sides. DISCUSSION and CONCLUSION: Although complications can occur, improved familiarity with the regional anatomy would lower incidences of death and morbidity during surgeries. While we believe that our morphometric and topographic evaluations will help guide surgeons and radiologists, wider series and multi-center studies should be done.

Cerrahi yaklaşım açısından hipofizer fossa ile ilişkili yapıların morfometrik analizi

GİRİŞ ve AMAÇ: Kafa tabanının morfometrik ve topografik anatomisinin önemi birçok nöroşirürji ve radyoloji yazısında yer almaktadır. Çalışmamızın amacı cerrahi koridorları tanımlamak ve cerrahi yaklaşımda güvenli mesafeler oluşturulmasına yardımcı olunmasını sağlayacak ortalama mesafelerin belirlenmesidir. YÖNTEM ve GEREÇLER: Dokuz Eylül Üniversitesi Tıp Fakültesi Anatomi Anabilim Dalı Laboratuvarına ait 16 adet kuru kemik cranium incelendi. Tüm kafatası tabanlarında foramen lacerum, foramen rotundum, foramen ovale, fossa hypophysialis, processus clinoideus anterior ve processus clinoideus posterior belirlendi ve bu parametreler arasındaki mesafeler dijital Vernier kumpas ile ölçüldü. BULGULAR: Foramen rotundum'un sağ taraftaki processus clinoideus anterior'a olan uzaklığı soldan daha büyüktü (p: 0,41). Foramen ovale'nin sol taraftaki processus clinoides posterior'a olan uzaklığı sağdan daha büyüktü (p: 0.010). Diğer parametrelerde sol ve sağ taraflar arasında istatistiksel olarak anlamlı fark yoktu. TARTIŞMA ve SONUÇ: Operasyonlar sırasında komplikasyonlar ortaya çıksa da bölgesel anatomiye hakim olunması; ölüm ve morbidite insidansını azaltmaktadır. Yapmış olduğumuz morfometrik ve topografik değerlendirmelerimizin cerrah ve radyologlara rehberlik edeceğine inanmakla birlikte daha geniş ve çok merkezli serilere ihtiyaç vardır.

PDF

___

1. Vinodkumar Velayudhan, Michael D. Luttrull, Thomas P. Naidich Imaging of the Brain: Expert Radiology Series, Saunders Press; 2012. Chapter 14, Sella Turcica and Pituitary Gland

2. Moore KL, Dalley AF, Agur AMR, Clinically Oriented Anatomy. 6th Ed. Lippincott Williams&Wilkin, USA 2010: 965-74

3. O. K. Bejjani, D. C. Wright, B. Sullivan, W. Oan, E. Salas-Lopez, A. Nadel, L. N. Sekhar. The anterior cranial fossa: Surgical anatomy. Skull Base Surgery, 7 (SUPPL. 1), 34.

4. Mohebbi, Shahin Rajaeih, Mahdi Safdarian, Parisa Omidian. The sphenoid sinus, foramen rotundum and vidian canal: a radiological study of anatomical relationships. Braz J Otorhinolaryngol. 2017;83(4):381-7

5. Tulika Gupta, Sunil Kumar Gupta. Original landmarks for intraoperative localization of the foramen ovale: a radio-anatomical study. Surgical and Radiologic Anatomy 2012; 34:8, 767-72.

6. Emine Dondu Kizilkanat, Neslihan Boyan, Ibrahim Tekdemir, Roger Soames, Ozkan Oguz. Surgical Importance of the Morphometry of the Anterior and Middle Cranial Fossae. Neurosurg Q Volume 17, Number 1, March 2007

7. Matthew J. Zdilla, Scott A. Hatfield, Kelsey R. Mangus. (2016) Angular Relationship Between the Foramen Ovale and the Trigeminal Impression. Journal of Craniofacial Surgery 27:8, 2177-80.

8. S.Melmed, D. Kleinberg, Williams Textbook of Endocrinology, Philadephia, Saunders, 2003, 177-182

9. Wang Q, Lan Q, Lu X J. Extended endoscopic endonasal transsphenoidal approach to the suprasellar region: anatomic study and clinical considerations. J Clin Neurosci. 2010;17(3):342-6.

10. Asem Salma, M.D.,1 Nishanta B. Baidya, M.D.,1 Benjamin Wendt, B.S.,1 Francisco Aguila, B.S.,2 Steffen Sammet, M.D.,2 and Mario Ammirati, M.D.,Qualitative and Quantitative Radio-Anatomical Variation of the Posterior Clinoid Process. Skull Base. 2011 Nov; 21(6): 373- 8.

11. Paul S, Das S. Anomalous posterior clinoid processes and its clinical importance. Columbia- Me´dica 2007;38(3):301–4

12. Kaplan M1, Erol FS, Ozveren MF, Topsakal C, Sam B, Tekdemir I. Review of complications due to foramen ovale puncture. J Clin Neurosci. 2007 Jun;14(6):563-8. Epub 2006 Dec 13.

13. Peris-Celda M1, Graziano F, Russo V, Mericle RA, Ulm AJ. Foramen ovale puncture, lesioning accuracy, and avoiding complications: microsurgical anatomy study with clinical implications. J Neurosurg. 2013 Nov;119(5):1176- 93.

14. Teul, I.; Czerwinski, F.; Gawlikowska, A.; Konstanty-Kurkiewicz, V. & Slawinski, G. Asymmetry of the ovale and spinous foramina in mediaeval and contemporary skulls in radiological examinations. Folia Morphol. (Warsz), 61(3):147- 52, 2002.

15. Cavallo L M, Cappabianca P, Galzio R, Iaconetta G, de Divitiis E, Tschabitscher M. Endoscopic transnasal approach to the cavernous sinus versus transcranial route: anatomic study. Neurosurgery. 2005;56(2, Suppl):379–389. discussion 379–89.

16. Kassam A, Snyderman C H, Mintz A, Gardner P, Carrau R L. Expanded endonasal approach: the rostrocaudal axis. Part I. Crista galli to the sella turcica. Neurosurg Focus. 2005;19(1):E3.

17. Nadire Unver Dogan , Zeliha Fazlıogulları, Ismihan Ilknur Uysal, Muzaffer Seker, Ahmet Kagan Karabulut. Anatomical Examination of the Foramens of the Middle Cranial Fossa Int. J. Morphol., 32(1):43-8, 2014.

18. Tumul Chowdhury, Hemanshu Prabhakar,1 Parmod K. Bithal,1 Bernhard Schaller,2 and Hari Hara Dash. Immediate postoperative complications in transsphenoidal pituitary surgery: A prospective study.Saudi J Anaesth. 2014 Jul-Sep; 8(3): 335–41.

19. Ciric Ivan, Ragin Ann, Baumgartner Craig, PA-C, MBA; Pierce Debi, Complications of Transsphenoidal Surgery: Results of a National Survey, Review of the Literature, and Personal Experience .Neurosurgery, Volume 40, Issue 2, 1 February 1997, Pages 225–37.