Microanatomy And Neuroimaging Study Of Intercavernous Sinuses And Its Adjacent Structure And Clinicial Significance

Objectives To explore the microanatomic and sectional anatomic features ofintercavernous sinuses and its related structure, in order to understand the position andthe shape features of intercavernous sinuses, provide anatomic basis for identification ofintercavernous sinus in radiology imaging; Observation of the photograph features ofbody tissues in magnetic resonance imaging, to choose right method to observe theposition、shape characteristic and size of intercavernous sinuses, the preoperativevenogram is useful to improve the success rate and reduce complications of surgery. Tomeasure the size of sphenoidal、pituitary and intercavernous sinuses, analyzing therelations between them.Method1.①Sectional cadaveric specimens: Selected6human heads which wereembedded by gelatin solution and were cut into contiguous sections in transverse,sagittal and coronal plane, then observed the occurrence rate、shape and position ofintercavernous sinuses.②Microanatomy: A total of18human cadavers, saw headalong the midline sagittal line off, observed the occurrence rate、shape and position ofintercavernous sinuses, then measure the size of every intercavernous sinus(includedanteroposterior and supra-inferior diameters).③Magnetic resonance angiography:Selected24patients, everyone were confirmed without sellar turcica region diseasesand cerebral diseases, followed by magnetic resonance imaging(MRI) and ContrastEnhanced magnetic resonance venous angiography(CE-MRV), the photograph sent toGE AW4.4or4.2workstation, used Maximum pixel intensity projection(maximumpixel intensity projection, MIP) to reconstructe cerebral veins, observed the shape、 position and measured the size of intercavernous sinuses, the result compraved to whichof microanatomy.Results1. Sectional anatomy: Head specimen (horizontal) shows the specific location andthe overall shape of the anterior intercavernous sinus; Head specimen (coronal) shows theshape of anterior and inferior intercavernous sinus; Head specimen (sagittal) shows thelocation and the shape of anterior、inferior、posterior intercavernous sinus、dorsum sellasinus and basilar sinus.2. Microanatomy: Anterior intercavernous sinus situated in frontof and superior to pituitary, most like triangle, few present oval; Inferior intercavernoussinus situated under pituitary(most were lied between anterior pituitary and posteriorpitutitary), mostly like moom shape or oval, the other present crack; posteriorintercavernous sinus situated upward pitutitary, most like oval; Dorsum sella sinussituated in the bone of dorsum sella or the dura mater above the dorsum sella, mostpresent round in irregular; Basilar sinus situated at the back of slope, which was betweenthe periostium of slope and the dura mater, mostly was made up of cards or bands ofcrack.3. CE-MRV observations: pitutitary uniform reinforcement taked on high signal, bemarked with pitutitary, CE-MRV could display the position and shape of everyintercavernous sinus, which were taked on high signal surrounding pitutitary. Theposition and shape were about the same to the microanatomy, dorsum sella communicatedwith basilar sinus downward, sometimes the separatrice was not clear. The coronal andsagittal image could observed intercavernous sinus helply, including the anteriorintercavernous sinus was presented the most clear in transverse view, inferiorintercavernous sinus was presented the most clear in coronal view. According to themmake sure sagittal image further.4. Microanatomy and CE-MRV comparativeobservations: microanatomy revealed the occurrence rate of anterior intercavernous sinuswas78%, the occurrence rate of inferior intercavernous sinus was61%, the occurrencerate of posterior intercavernous sinus was28%, the occurrence rate of dorsum sella sinuswas56%and basilar sinus was100%. Compared to the dissection, CE-MRV revealed37%anterior intercavernous sinus,48%inferior intercavernous sinus,30%posterior intercavernous sinus,30%dorsum sella sinus and100%basilar sinus.5. Type of thecavernous sinus: According to anterior and inferior intercavernous sinus which wereappeared or not, divided it into only anterior intercavernous sinus, only inferiorintercavernous sinus, anterior and inferior intercavernous sinus, neither anterior norinferior intercavernous sinus, CE-MRV could reveale these four types.6. The relationshipof Sphenoid sinus and cavernous sinus: the size of sphenoid sinus and cavernous sinuswas negative.7. The relationship of pituitary and cavernous sinus: the size of pituitaryand cavernous sinus was no direct relationship:Conclusion1. The rate of the intercavernous sinuses is high, familiar with the locationand shape of them, which can avoid to injuy the intercavernous sinuses and reducebleeding rate in operation、decrease complications after operation;2. CE-MRV coulddirect to observe the location and shape of the intercavernous sinuses, which was aneffective means of preoperative examination of transsphenoidal surgery;3. Thecorrelation which negative between the growth degree of sphenoid sinus(size) and thesize of intercavernous sinuses, the bigger of sphenoid sinus, the smaller ofintercavernous sinuses;4. There was no direct relationship between the size of pituitaryand intercavernous sinuses.