Vascular Complications of Intercavernous Sinuses during Transsphenoidal Surgery: An Anatomical Analysis Based on Autopsy and Magnetic Resonance Venography.

Shijun Chen,Wen Song,Xuefei Deng,Ya Bai,Yongchao Chen,Bin Liu,Dongxue Li,Hui Han,Heye Zhang

doi:10.1371/journal.pone.0144771

Abstract

PurposeVascular complications induced by intercavernous sinus injury during dural opening in the transsphenoidal surgery may contribute to incomplete tumour resections. Preoperative neuro-imaging is of crucial importance in planning surgical approach. The aim of this study is to correlate the microanatomy of intercavernous sinuses with its contrast-enhanced magnetic resonance venography (CE-MRV).MethodsEighteen human adult cadavers and 24 patients were examined based on autopsy and CE-MRV. Through dissection of the cadavers and CE-MRV, the location, shape, number, diameter and type of intercavernous sinuses were measured and compared.ResultsDifferent intercavernous sinuses were identified by their location and shape in all the cadavers and CE-MRV. Compared to the cadavers, CE-MRV revealed 37% of the anterior intercavernous sinus, 48% of the inferior intercavernous sinus, 30% of the posterior intercavernous sinus, 30% of the dorsum sellae sinus and 100% of the basilar sinus. The smaller intercavernous sinuses were not seen in the neuro-images. According to the presence of the anterior and inferior intercavernous sinus, four types of the intercavernous sinuses were identified in cadavers and CE-MRV, and the corresponding operative space in the transsphenoidal surgical approach was implemented.ConclusionThe morphology and classification of the cavernous sinus can be identified by CE-MRV, especially for the larger vessels, which cause bleeding more easily. Therefore, CE-MRV provides a reliable measure for individualized preoperative planning during transsphenoidal surgery.

Highlights

The intercavernous sinuses are the venous interconnections between the bilateral cavernous sinuses in the dura mater around the pineal gland
Different intercavernous sinuses were identified by their location and shape in all the cadavers and contrast-enhanced magnetic resonance venography (CE-MRV)
CE-MRV revealed 37% of the anterior intercavernous sinus, 48% of the inferior intercavernous sinus, 30% of the posterior intercavernous sinus, 30% of the dorsum sellae sinus and 100% of the basilar sinus

Summary

Introduction

The intercavernous sinuses are the venous interconnections between the bilateral cavernous sinuses in the dura mater around the pineal gland. Transsphenoidal surgery has been well established as an effective primary treatment for tumours of the sellar region due to its minimal invasiveness, low morbidity and excellent surgical outcome [6,7,8,9]. The intercavernous sinuses (especially the anterior and inferior intercavernous sinuses) are prone to bleeding under inappropriate manipulation, and may lead to poor visualization, inadequate exposure, and incomplete tumour resection [10,11,12,13]. Imaging analysis of the sellar region is of high importance in the planning, execution and outcome of the transsphenoidal surgery [14,15,16]. Preoperative neuro-radiological information on the intercavernous sinus may be of crucial importance for avoiding bleeding in transsphenoidal surgery

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