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Published in: Surgical and Radiologic Anatomy 5/2019

01-05-2019 | Magnetic Resonance Imaging | Original Article

The diaphragma sellae, diaphragm opening, and subdiaphragmatic cistern: an anatomical study using magnetic resonance imaging

Authors: Satoshi Tsutsumi, Hideo Ono, Yukimasa Yasumoto, Hisato Ishii

Published in: Surgical and Radiologic Anatomy | Issue 5/2019

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Abstract

Purpose

Few studies have explored the detailed morphology of the diaphragma sellae (DS), diaphragm opening (DO) or stoma, and subdiaphragmatic cistern (SDC) using neuroimages. The aim of the present study was to characterize these structures using magnetic resonance imaging.

Methods

Thin-sliced, sagittal and coronal T2-weighted imaging was performed for a total of 84 outpatients.

Results

The DS, DO, SDC, and relevant structures were consistently delineated in all patients. In 66% of patients, all three structures appeared to be highly variable, and were classifiable as six distinct morphological types. In 4% of patients, the DS presented as a complete sheet lacking a discernible DO. In addition, 30% of the patients presented with undiscernible SDCs. In the coronal sections of 11% of patients, the pituitary glands extended laterally, reaching or extending beyond the center line on the sectional image of the cavernous internal carotid artery.

Conclusions

Thin-sliced, sagittal, and coronal T2-weighted sequences are useful for delineating the DS, DO, and SDC. Morphological variation of these structures among individuals may considerably influence the direction of pituitary tumor expansion.
Literature
1.
go back to reference Abuzayed B, Tanriöver N, Ozlen F, Gazioğlu N, Ulu MO, Eraslan B, Akar Z (2009) Endoscopic endonasal transsphenoidal approach to the sellar region. Results of endoscopic dissection on 30 cadavers. Turk Neurosurg 19:237–244PubMed Abuzayed B, Tanriöver N, Ozlen F, Gazioğlu N, Ulu MO, Eraslan B, Akar Z (2009) Endoscopic endonasal transsphenoidal approach to the sellar region. Results of endoscopic dissection on 30 cadavers. Turk Neurosurg 19:237–244PubMed
2.
go back to reference Campero A, Martins C, Yasuda A, Rhoton AL Jr (2008) Microsurgical anatomy of the diaphragma sellae and its role in direction the pattern of growth of pituitary adenomas. Neurosurgery 62:717–723CrossRefPubMed Campero A, Martins C, Yasuda A, Rhoton AL Jr (2008) Microsurgical anatomy of the diaphragma sellae and its role in direction the pattern of growth of pituitary adenomas. Neurosurgery 62:717–723CrossRefPubMed
3.
go back to reference Cebula H, Kurbanov A, Zimmer LA, Poczos P, Leach JL, De Battista JC, Froelich S, Theodosopoulos PV, Keller JT (2014) Endoscopic endonasal variability in the anatomy of the internal carotid artery. World Neurosurg 82:e759–e764CrossRefPubMed Cebula H, Kurbanov A, Zimmer LA, Poczos P, Leach JL, De Battista JC, Froelich S, Theodosopoulos PV, Keller JT (2014) Endoscopic endonasal variability in the anatomy of the internal carotid artery. World Neurosurg 82:e759–e764CrossRefPubMed
4.
go back to reference Cho KH, Rodríguez-Vázquez JF, Han EH, Verdugo-López S, Murakami G, Cho BH (2010) Human primitive meninges in and around the mesencephalic flexure and particularly their topographical relation to cranial nerves. Ann Anat 192:322–328CrossRefPubMed Cho KH, Rodríguez-Vázquez JF, Han EH, Verdugo-López S, Murakami G, Cho BH (2010) Human primitive meninges in and around the mesencephalic flexure and particularly their topographical relation to cranial nerves. Ann Anat 192:322–328CrossRefPubMed
5.
go back to reference Ciappetta P, Pescatori L (2017) Anatomic dissection of arachnoid membranes encircling the pituitary stalk on fresh, non-formalin-fixed specimens: anatomoradiologic correlations and clinical applications in craniopharyngioma surgery. World Neurosurg 108:479–490CrossRefPubMed Ciappetta P, Pescatori L (2017) Anatomic dissection of arachnoid membranes encircling the pituitary stalk on fresh, non-formalin-fixed specimens: anatomoradiologic correlations and clinical applications in craniopharyngioma surgery. World Neurosurg 108:479–490CrossRefPubMed
6.
go back to reference Daniels DL, Pojunas KW, Kilgore DP, Pech P, Meyer GA, Williams AL, Haughton VM (1986) MR of the diaphragms sellae. AJNR Am J Neuroradiol 7:765–769PubMed Daniels DL, Pojunas KW, Kilgore DP, Pech P, Meyer GA, Williams AL, Haughton VM (1986) MR of the diaphragms sellae. AJNR Am J Neuroradiol 7:765–769PubMed
7.
go back to reference Destrieux C, Kakou MK, Velut S, Lefrancq T, Jan M (1998) Microanatomy of the hypophyseal fossa boundaries. J Neurosurg 88:743–752CrossRefPubMed Destrieux C, Kakou MK, Velut S, Lefrancq T, Jan M (1998) Microanatomy of the hypophyseal fossa boundaries. J Neurosurg 88:743–752CrossRefPubMed
8.
go back to reference Di leva A, Tschabitscher M, Matula C, Komatsu F, Komatsu M, Colombo G, Sherif C, Galzio RJ (2012) The subdiaphragmatic cistern: historic and radioanatomic findings. Acta Neurochir (Wien) 154:667–674CrossRef Di leva A, Tschabitscher M, Matula C, Komatsu F, Komatsu M, Colombo G, Sherif C, Galzio RJ (2012) The subdiaphragmatic cistern: historic and radioanatomic findings. Acta Neurochir (Wien) 154:667–674CrossRef
9.
go back to reference Doraiswamy PM, Potts JM, Axelson DA, Husain MM, Lurie SN, Na C, Eacalona PR, McDonald WM, Figiel GS, Ellinwood EH Jr et al (1992) MR assessment of pituitary gland morphology in healthy volunteers: age- and gender-related differences. AJNR Am J Neuroradiol 13:1295–1299PubMed Doraiswamy PM, Potts JM, Axelson DA, Husain MM, Lurie SN, Na C, Eacalona PR, McDonald WM, Figiel GS, Ellinwood EH Jr et al (1992) MR assessment of pituitary gland morphology in healthy volunteers: age- and gender-related differences. AJNR Am J Neuroradiol 13:1295–1299PubMed
10.
go back to reference Ferreri AJ, Garrido SA, Markarian MG, Yañez A (1992) Relationship between the development of diaphragma sellae and morphology of the sella turcica and its content. Surg Radiol Anat 14:233–239CrossRefPubMed Ferreri AJ, Garrido SA, Markarian MG, Yañez A (1992) Relationship between the development of diaphragma sellae and morphology of the sella turcica and its content. Surg Radiol Anat 14:233–239CrossRefPubMed
11.
go back to reference Guinto Balanzar G, Abdo M, Mercado M, Guinto P, Nishimura E, Arechiga N (2011) Diaphragma sellae: a surgical reference for transsphenoidal resection of pituitary macroadenomas. World Neurosurg 75:286–293CrossRefPubMed Guinto Balanzar G, Abdo M, Mercado M, Guinto P, Nishimura E, Arechiga N (2011) Diaphragma sellae: a surgical reference for transsphenoidal resection of pituitary macroadenomas. World Neurosurg 75:286–293CrossRefPubMed
12.
go back to reference Guitelman M, Garcia Basavilbaso N, Vitale M, Chervin A, Katz D, Miragaya K, Herrera J, Cornalo D, Servidio M, Boero L, Manavela M, Danilowicz K, Alfieri A, Stalldecker G, Glerean M, Fainstein Day P, Ballarino C, Mallea Gil MS, Rogozinski A (2013) Primary empty sella (PES): a review of 175 cases. Pituitary 16:270–274CrossRefPubMed Guitelman M, Garcia Basavilbaso N, Vitale M, Chervin A, Katz D, Miragaya K, Herrera J, Cornalo D, Servidio M, Boero L, Manavela M, Danilowicz K, Alfieri A, Stalldecker G, Glerean M, Fainstein Day P, Ballarino C, Mallea Gil MS, Rogozinski A (2013) Primary empty sella (PES): a review of 175 cases. Pituitary 16:270–274CrossRefPubMed
13.
go back to reference Gulsen S, Dinc AH, Unal M, Cantürk N, Altinors N (2010) Characterization of the anatomic location of the pituitary stalk and its relationship to the dorsum sellae, tuberculum sellae and chiasmatic cistern. J Korean Neurosurg Soc 47:169–173CrossRefPubMedPubMedCentral Gulsen S, Dinc AH, Unal M, Cantürk N, Altinors N (2010) Characterization of the anatomic location of the pituitary stalk and its relationship to the dorsum sellae, tuberculum sellae and chiasmatic cistern. J Korean Neurosurg Soc 47:169–173CrossRefPubMedPubMedCentral
14.
go back to reference Ju KS, Bae HG, Park HK, Chang JC, Choi SK, Sim KB (2010) Morphometric study of the Korean adult pituitary glands and the diaphragma sellae. J Korean Neurosurg Soc 47:42–47CrossRefPubMedPubMedCentral Ju KS, Bae HG, Park HK, Chang JC, Choi SK, Sim KB (2010) Morphometric study of the Korean adult pituitary glands and the diaphragma sellae. J Korean Neurosurg Soc 47:42–47CrossRefPubMedPubMedCentral
15.
go back to reference Knosp E, Steiner E, Kitz K, Matula C (1993) Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery 33:610–618PubMed Knosp E, Steiner E, Kitz K, Matula C (1993) Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery 33:610–618PubMed
16.
go back to reference Kursat E, Yilmazlar S, Aker S, Aksoy K, Oyguch H (2008) Comparison of lateral and superior walls of the pituitary fossa with clinical emphasis on pituitary adenoma extension: cadaveric-anatomic study. Neurosurg Rev 31:91–98CrossRefPubMed Kursat E, Yilmazlar S, Aker S, Aksoy K, Oyguch H (2008) Comparison of lateral and superior walls of the pituitary fossa with clinical emphasis on pituitary adenoma extension: cadaveric-anatomic study. Neurosurg Rev 31:91–98CrossRefPubMed
17.
go back to reference Lee KF, Parke W, Lin SR, Choi HY, Schatz NJ (1978) The vasculature of the diaphragma sellae. A postmortem injection study. Neuroradiology 16:281–283CrossRefPubMed Lee KF, Parke W, Lin SR, Choi HY, Schatz NJ (1978) The vasculature of the diaphragma sellae. A postmortem injection study. Neuroradiology 16:281–283CrossRefPubMed
18.
go back to reference Nomura M, Tachibana O, Yamashima T, Yamashita J, Suzuki M (2002) MRI evaluation of the diaphragmal opening: using MRI parallel to the transsphenoidal surgical approach. J Clin Neurosci 9:175–177CrossRefPubMed Nomura M, Tachibana O, Yamashima T, Yamashita J, Suzuki M (2002) MRI evaluation of the diaphragmal opening: using MRI parallel to the transsphenoidal surgical approach. J Clin Neurosci 9:175–177CrossRefPubMed
19.
20.
go back to reference Sage MR, Blumbergs PC, Fowler GW (1982) The diaphragma sellae: its relationship to normal sellar variations in frontal radiographic projections. Radiology 145:699–701CrossRefPubMed Sage MR, Blumbergs PC, Fowler GW (1982) The diaphragma sellae: its relationship to normal sellar variations in frontal radiographic projections. Radiology 145:699–701CrossRefPubMed
21.
go back to reference Sage MR, Blumbergs PC, Mulligan BP, Fowler GW (1982) The diaphragma sellae: its relationship to the configuration of the pituitary gland. Radiology 145:703–708CrossRefPubMed Sage MR, Blumbergs PC, Mulligan BP, Fowler GW (1982) The diaphragma sellae: its relationship to the configuration of the pituitary gland. Radiology 145:703–708CrossRefPubMed
22.
go back to reference Thines L, Lee SK, Dehdashti AR, Agid R, Willinsky RA, Wallace CM, Terbrugge KG (2009) Direct imaging of the distal dural ring and paraclinoid internal carotid artery aneurysms with high-resolution T2 turbo-spin echo technique at 3-T magnetic resonance imaging. Neurosurgery 64:1059–1064CrossRefPubMed Thines L, Lee SK, Dehdashti AR, Agid R, Willinsky RA, Wallace CM, Terbrugge KG (2009) Direct imaging of the distal dural ring and paraclinoid internal carotid artery aneurysms with high-resolution T2 turbo-spin echo technique at 3-T magnetic resonance imaging. Neurosurgery 64:1059–1064CrossRefPubMed
23.
go back to reference Tsunoda A, Okuda O, Sato K (1997) HR height of the pituitary gland as a function of age and sex: especially physiological hypertrophy in adolescence and in climacterium. AJNR Am J Neuroradiol 81:914–920 Tsunoda A, Okuda O, Sato K (1997) HR height of the pituitary gland as a function of age and sex: especially physiological hypertrophy in adolescence and in climacterium. AJNR Am J Neuroradiol 81:914–920
24.
go back to reference Umansky F, Valarezo A, Elidan J (1994) The superior wall of the cavernous sinus: a microanatomical study. J Neurosurg 81:914–920CrossRefPubMed Umansky F, Valarezo A, Elidan J (1994) The superior wall of the cavernous sinus: a microanatomical study. J Neurosurg 81:914–920CrossRefPubMed
25.
go back to reference Won HS, Han SH, Oh CS, Lee JI, Chung IH, Kim SH (2010) Topographic variations of the optic chiasm and the foramen diaphragma sellae. Surg Radiol Anat 32:653–657CrossRefPubMed Won HS, Han SH, Oh CS, Lee JI, Chung IH, Kim SH (2010) Topographic variations of the optic chiasm and the foramen diaphragma sellae. Surg Radiol Anat 32:653–657CrossRefPubMed
26.
go back to reference Yohannan DG, Krishnapillai R, Suresh R, Ramnarayan S (2015) A morphometric study of diaphragma sellae and delineation of its relation to optic neural pathways through computer aided superimposition. Anat Res Int 618042 Yohannan DG, Krishnapillai R, Suresh R, Ramnarayan S (2015) A morphometric study of diaphragma sellae and delineation of its relation to optic neural pathways through computer aided superimposition. Anat Res Int 618042
Metadata
Title
The diaphragma sellae, diaphragm opening, and subdiaphragmatic cistern: an anatomical study using magnetic resonance imaging
Authors
Satoshi Tsutsumi
Hideo Ono
Yukimasa Yasumoto
Hisato Ishii
Publication date
01-05-2019
Publisher
Springer Paris
Published in
Surgical and Radiologic Anatomy / Issue 5/2019
Print ISSN: 0930-1038
Electronic ISSN: 1279-8517
DOI
https://doi.org/10.1007/s00276-019-02184-0

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