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J Neurol Surg B Skull Base 2021; 82(03): 365-369
DOI: 10.1055/s-0039-3400298
Original Article

Anatomical Predictors of Transcranial Surgical Access to the Suprasellar Space

David Straus
1   Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
,
Daniel B. Eddelman
1   Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
,
Nika Byrne
1   Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
,
Konstantin Tchalukov
2   Rush Medical College, Rush University Medical Center, Chicago, Illinois, United States
,
Josh Wewel
1   Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
,
Stephan A. Munich
1   Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
,
Mehmet Kocak
3   Department of Radiology, Rush University Medical Center, Chicago, Illinois, United States
,
Richard Byrne
1   Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
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Abstract

Objective The suprasellar space is a common location for intracranial lesions. The position of the optic chiasm (prefixed vs. postfixed) results in variable sizes of operative corridors and is thus important to identify when choosing a surgical approach to this region. In this study, we aim to identify relationships between suprasellar anatomy and external cranial metrics to guide in preoperative planning.

Methods T2-weighted magnetic resonance images (MRIs) from 50 patients (25 males and 25 females) were analyzed. Various intracranial and extracranial metrics were measured. Statistical analysis was performed to determine any associations between metrics.

Results Interoptic space (IOS) size correlated with interpupillary distance (IPD; a = 7.3, 95% confidence interval [CI] = 4.5–10.0, R 2 = 0.3708, p = 0.0009). IOS size also correlated with fixation of the optic chiasm, for prefixed chiasms (n = 7), the mean IOS is 205.14 mm2, for normal chiasm position (n = 33) the mean IOS is 216.94 mm2 and for postfixed chiasms (n = 10) the mean IOS is 236.20 mm2 (p = 0.002). IPD correlates with optic nerve distance (OND; p = 0.1534). Cranial index does not predict OND, IPD, or IOS.

Conclusion This study provides insight into relationships between intracranial structures and extracranial metrics. This is the first study to describe a statistically significant correlation between IPD and IOS. Surgical approach can be guided in part by the size of the IOS and its correlates. Particularly small intraoptic space may guide the surgeon away from a subfrontal approach.

Keywords

suprasellar - intraoptic space - subfrontal approach - transsylvian approach


Publication History

Received: 03 July 2019

Accepted: 06 October 2019

Article published online:
14 November 2019

© 2019. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Fahlbusch R, Schott W. Pterional surgery of meningiomas of the tuberculum sellae and planum sphenoidale: surgical results with special consideration of ophthalmological and endocrinological outcomes. J Neurosurg 2002; 96 (02) 235-243
    Google Scholar
  • 2 Figueiredo EG, Deshmukh V, Nakaji P. et al. An anatomical evaluation of the mini-supraorbital approach and comparison with standard craniotomies. Neurosurgery 2006; 59 (04) (Suppl. 02) ONS212-ONS220 , discussion ONS220
    PubMedGoogle Scholar
  • 3 Jiang ZL, Ren XH, Chu JS, Lin S, Zhang MZ. [Microsurgical treatment of adult craniopharyngiomas in 156 cases]. Zhonghua Yi Xue Za Zhi 2010; 90 (05) 291-294
    PubMedGoogle Scholar
  • 4 Kazkayasi M, Batay F, Bademci G, Bengi O, Tekdemir I. The morphometric and cephalometric study of anterior cranial landmarks for surgery. Minim Invasive Neurosurg 2008; 51 (01) 21-25
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Kendir S, Acar HI, Comert A. et al. Window anatomy for neurosurgical approaches. Laboratory investigation. J Neurosurg 2009; 111 (02) 365-370
    Google Scholar
  • 6 Ormond DR, Hadjipanayis CG. The supraorbital keyhole craniotomy through an eyebrow incision: its origins and evolution. Minim Invasive Surg 2013; 2013: 296469
    Google Scholar
  • 7 Raso JL, Gusmão SNS. A new landmark for finding the sigmoid sinus in suboccipital craniotomies. Neurosurgery 2011;68(1, Suppl Operative):1–6, discussion 6
    Google Scholar
  • 8 Shi XE, Wu B, Zhou ZQ, Fan T, Zhang YL. Microsurgical treatment of craniopharyngiomas: report of 284 patients. Chin Med J (Engl) 2006; 119 (19) 1653-1663
    CrossrefPubMedGoogle Scholar
  • 9 Tubbs RS, Loukas M, Shoja MM, Bellew MP, Cohen-Gadol AA. Surface landmarks for the junction between the transverse and sigmoid sinuses: application of the “strategic” burr hole for suboccipital craniotomy. Neurosurgery 2009;65(6, Suppl):37–41, discussion 41
    Google Scholar
  • 10 Bonicki W, Michalik R, Krajewski R, Kukwa A, Oziebło A. [Skull base surgery techniques in the treatment of pituitary adenomas]. Neurol Neurochir Pol 2002; 36 (06) 1121-1130 , discussion 1131–1133
    PubMedGoogle Scholar
  • 11 Cavallo LM, de Divitiis O, Aydin S. et al. Extended endoscopic endonasal transsphenoidal approach to the suprasellar area: anatomic considerations--part 1. Neurosurgery 2008; 62 (06) (Suppl. 03) 1202-1212
    CrossrefPubMedGoogle Scholar
  • 12 Chokyu I, Goto T, Ishibashi K, Nagata T, Ohata K. Bilateral subfrontal approach for tuberculum sellae meningiomas in long-term postoperative visual outcome. J Neurosurg 2011; 115 (04) 802-810
    CrossrefPubMedGoogle Scholar
  • 13 Cotton F, Rozzi FR, Vallee B. et al. Cranial sutures and craniometric points detected on MRI. Surg Radiol Anat 2005; 27 (01) 64-70
    CrossrefPubMedGoogle Scholar
  • 14 Fernandez-Miranda JC, Gardner PA, Snyderman CH. et al. Craniopharyngioma: a pathologic, clinical, and surgical review. Head Neck 2012; 34 (07) 1036-1044
    CrossrefPubMedGoogle Scholar
  • 15 Figueiredo EG, Deshmukh P, Zabramski JM, Preul MC, Crawford NR, Spetzler RF. The pterional-transsylvian approach: an analytical study. Neurosurgery 2008; 62 (06) (Suppl. 03) 1361-1367
    CrossrefPubMedGoogle Scholar
  • 16 Gusmão S, Silveira RL, Arantes A. [Landmarks to the cranial approaches]. Arq Neuropsiquiatr 2003; 61 (2A): 305-308
    PubMedGoogle Scholar
  • 17 Hardy J. [History of pituitary surgery]. Neurochirurgie 2010; 56 (04) 358-362
    CrossrefPubMedGoogle Scholar
  • 18 Landeiro JA, Gonçalves MB, Guimarães RD. et al. Tuberculum sellae meningiomas: surgical considerations. Arq Neuropsiquiatr 2010; 68 (03) 424-429
    CrossrefPubMedGoogle Scholar
  • 19 Mura JM, Torche E, de Oliveira E. Unilateral subfrontal approach to anterior communicating artery aneurysms: A review of 28 patients. Surg Neurol Int 2013; 4: 4
    CrossrefPubMedGoogle Scholar
  • 20 Reisch R, Perneczky A. Ten-year experience with the supraorbital subfrontal approach through an eyebrow skin incision. Neurosurgery 2005;57(4, Suppl):242–255, discussion 242–255
    Google Scholar
  • 21 Shi X-E, Wu B, Fan T, Zhou Z-Q, Zhang Y-L. Craniopharyngioma: surgical experience of 309 cases in China. Clin Neurol Neurosurg 2008; 110 (02) 151-159
    CrossrefPubMedGoogle Scholar
  • 22 Usanov EI, Kiselev AS, Svistov DV. [Modification of transcranial subfrontal approach to the chiasmal-sellar region]. Vestn Khir Im I I Grek 1989; 143 (09) 134-135
    PubMedGoogle Scholar
  • 23 Guthikonda B, Tobler Jr. WD, Froelich SC. et al. Anatomic study of the prechiasmatic sulcus and its surgical implications. Clin Anat 2010; 23 (06) 622-628
    CrossrefPubMedGoogle Scholar
  • 24 Hofmann BM, Höllig A, Strauss C, Buslei R, Buchfelder M, Fahlbusch R. Results after treatment of craniopharyngiomas: further experiences with 73 patients since 1997. J Neurosurg 2012; 116 (02) 373-384
    CrossrefPubMedGoogle Scholar
  • 25 Elwatidy SM. Adult craniopharyngioma. Clinical, radiological presentation and outcome of management. Neurosciences (Riyadh) 2004; 9 (04) 271-275
    PubMedGoogle Scholar
  • 26 Landeiro JA, Flores MS, Lopes CA, Lapenta MA, Ribeiro CH. [Subfrontal approach in sellar and suprasellar lesions]. Arq Neuropsiquiatr 2000; 58 (01) 64-70
    PubMedGoogle Scholar
  • 27 Salma A, Alkandari A, Sammet S, Ammirati M. Lateral supraorbital approach vs pterional approach: an anatomic qualitative and quantitative evaluation. Neurosurgery 2011;68(2, Suppl Operative):364–372, discussion 371–372
    Google Scholar