The inferior intercavernous sinus: An anatomical study with application to trans-sphenoidal approaches to the pituitary gland

Clin Neurol Neurosurg. 2020 Sep;196:106000. doi: 10.1016/j.clineuro.2020.106000. Epub 2020 Jun 6.

Abstract

Objectives: The inferior intercavernous sinus is located below the pituitary gland in the sella turcica. Its presence has been controversial among anatomists because it is not always found on radiological imaging or during cadaveric dissections; however, it is becoming a better-known structure in the neurosurgical and radiological fields, specifically with respect to transsphenoidal surgery. Therefore, the present study was performed to better elucidate this structure at the skull base.

Patients and methods: Fifty adult, latex injected cadavers underwent dissection. The presence or absence of the inferior cavernous sinus was evaluated and when present, measurements of its width and length were made. Its connections with other intradural venous sinuses were also documented.

Results: An inferior intercavernous sinus was identified in 26 % of specimens. In all specimens, it communicated with the left and right cavernous sinus. The average width and length were 3 mm and 9.5 mm, respectively. In the sagittal plane, the inferior intercavernous sinus was positioned anteriorly in 31 %, at the nadir of the sella turcica in 38 %, and slightly posterior to the nadir of the sella turcica in 31 %. In two specimens (15.4 %), the sinus was plexiform in its shape. In one specimen a diploic vein connected the basilar venous plexus to the inferior intercavernous sinus on its deep surface.

Conclusion: An improved understanding of the variable anatomy of the inferior intercavernous sinus is important in pathological, surgical, and radiological cases.

Keywords: Cavernous sinus; Inferior intercavernous sinus; Intercavernous sinus; Pituitary gland; Sella turcica; Transsphenoidal surgery.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cadaver
  • Cavernous Sinus / anatomy & histology*
  • Cavernous Sinus / diagnostic imaging
  • Cavernous Sinus / embryology
  • Craniotomy / methods*
  • Female
  • Humans
  • Hypophysectomy / methods*
  • Male
  • Middle Aged
  • Pituitary Gland / anatomy & histology
  • Pituitary Gland / blood supply
  • Pituitary Gland / diagnostic imaging
  • Pituitary Gland / surgery*
  • Sella Turcica / anatomy & histology*
  • Sella Turcica / diagnostic imaging
  • Sphenoid Bone / surgery*