Thaïs Cristina Rejane-Heim1,2,3,4, Giuliano Silveira-Bertazzo1, Ricardo L Carrau1,5, Daniel M Prevedello6,7. 1. Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, OH, USA. 2. Department of Pediatric Endocrinology, Nationwide Children's Hospital, Columbus, OH, USA. 3. Department of Pediatric Endocrinology, Federal University of Santa Catarina, Florianópolis, SC, Brazil. 4. Department of Pediatric Neuroendocrinology and Pediatric Endocrinology, Jeser Amarante Faria Children's Hospital, and Neurological and Neurosurgical Clinic of Joinville, Joinville, SC, Brazil. 5. Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Medical Center, Columbus, OH, USA. 6. Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, OH, USA. dprevedello@gmail.com. 7. Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Medical Center, Columbus, OH, USA. dprevedello@gmail.com.
Abstract
BACKGROUND: Excelsior knowledge of endoscopic anatomy and techniques to remove the natural barriers preventing full endonasal access to the interpeduncular and prepontine cisterns determines the ease of transposing the pituitary gland (hypophysiopexy) preserving the glandular function without manipulating the optic apparatus and the oculomotor nerves. METHODS: Throughout stepwise cadaveric dissections, we describe the expanded endonasal approach (EEA) to the interpeduncular and prepontine cisterns with special references to the intricate anatomy of the region and techniques for hypophysiopexy and posterior clinoidectomies. CONCLUSION: This article illustrates sellar-diaphragmatic dural incisions and various "pituitary gland transpositions" techniques performed via extradural (lifting the gland still covered by both dural layers), interdural (transcavernous), and intradural (between the medial wall of the cavernous sinus and the pituitary tunica) to access the prepontine and interpeduncular cisterns.
BACKGROUND: Excelsior knowledge of endoscopic anatomy and techniques to remove the natural barriers preventing full endonasal access to the interpeduncular and prepontine cisterns determines the ease of transposing the pituitary gland (hypophysiopexy) preserving the glandular function without manipulating the optic apparatus and the oculomotor nerves. METHODS: Throughout stepwise cadaveric dissections, we describe the expanded endonasal approach (EEA) to the interpeduncular and prepontine cisterns with special references to the intricate anatomy of the region and techniques for hypophysiopexy and posterior clinoidectomies. CONCLUSION: This article illustrates sellar-diaphragmatic dural incisions and various "pituitary gland transpositions" techniques performed via extradural (lifting the gland still covered by both dural layers), interdural (transcavernous), and intradural (between the medial wall of the cavernous sinus and the pituitary tunica) to access the prepontine and interpeduncular cisterns.