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Vol. 31. Issue 3.
Pages 112-118 (May - June 2020)
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Vol. 31. Issue 3.
Pages 112-118 (May - June 2020)
Clinical Research
The anatomic variations and surgical windows among optic chiasm/nerves and carotid arteries in the sellar region play a role in choosing the best surgical approaches: A Cadaveric study
Las variaciones anatómicas y las vías de acceso quirúrgico en el quiasma, los nervios ópticos y las arterias carótidas de la región selar influyen en la elección de los mejores abordajes quirúrgicos: un estudio en cadáveres
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Duygu Baykala, Selcuk Yilmazlara,
Corresponding author
yilmazlars@gmail.com

Corresponding author.
, Recep Fedakarb
a Department of Neurosurgery, School of Medicine, Bursa Uludag University, Bursa, Turkey
b Department of Forensic Medicine, School of Medicine, Bursa Uludag University, Bursa, Turkey
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Table 1. The structures that limit the anterior subchiasmal region in surgical approaches.
Table 2. Results of the measurements of subchiasmal region.
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Abstract
Objective

Understanding the relationship between the carotid artery, optic nerve and the anterior clinoid process is the basis of surgical approaches performed in the subchiasmal region. The location of the optic chiasm, the length of the optic nerves, and the distance and angle between the optic nerves determine the route of surgical approaches. We have determined the types of optic chiasm to study the relationship between vascular and neural structures in this region.

Materials and methods

Thirty autopsy specimens were investigated at the Bursa Forensic Medicine Institute for optic chiasm types and the relationship between the neural and vascular anatomical structures of the sellar–parasellar and subchiasmal region was examined between June 2016 and November 2016.

Results

In this study, 4 prefix types (13%), 6 postfix types (20%), and 20 central types (67%) of chiasm were defined. Furthermore, we measured this angle between two optic nerves, which indirectly shows the location of chiasm according to the diaphragma sellae, and then detected the mean value of this angle as 87.1±11.6°. The “limit” value to designate a chiasm as prefix was measured in the current study as ≥101.1°. The angle between optic nerves ranged from a mean value of 69.9±3.7° in 6 cases with postfix chiasm, to a mean value of 104.0±2.1° in 4 cases with prefix chiasm and a mean value of 88.8±6.7° in 20 cases with central chiasm.

Conclusion

In this study, we showed that the relationship among optic chiasma types, optic nerves and bony and vascular structures around the sellar area was effective at determining the surgical approach to this region.

Keywords:
Cadaveric study
Optic chiasm
Optic nerve
Internal carotid artery
Surgical approach
Resumen
Objetivo

Comprender la relación entre la arteria carótida, el nervio óptico y la apófisis clinoides anterior es la base de los tratamientos quirúrgicos realizados en la región subquiasmática. La ubicación del quiasma óptico, la longitud de los nervios ópticos, y la distancia y el ángulo entre dichos nervios determinan la vía de acceso quirúrgico. Hemos determinado los tipos de quiasma óptico para estudiar la relación entre las estructuras vasculares y neurales en esta región.

Materiales y métodos

Entre junio y noviembre de 2016, se analizaron 30 muestras de autopsia en el Instituto de Medicina Legal de Bursa (Turquía) para determinar los tipos de quiasma óptico, y examinar la relación entre las estructuras anatómicas neurales y vasculares de las regiones selar-paraselar y subquiasmática.

Resultados

En este estudio, se definieron 4 casos de quiasma prefijado (13%), 6 de quiasma posfijado (20%) y 20 de quiasma central (67%). Además, medimos el ángulo entre 2 nervios ópticos que muestra indirectamente la ubicación del quiasma según el diafragma selar, y luego detectamos el valor medio de este ángulo (87,1±11,6°). El valor «límite» para designar un quiasma como «prefijado» se midió en el estudio actual como ≥101,1°. El valor medio del ángulo entre los nervios ópticos osciló entre 69,9±3,7° en los 6 casos de quiasma posfijado, 104,0±2,1° en los 4 casos de quiasma prefijado y 88,8±6,7° en los 20 casos de quiasma central.

Conclusión

En este estudio, pusimos de manifiesto que la relación entre los tipos de quiasma óptico, los nervios ópticos y las estructuras óseas y vasculares alrededor del área selar fue eficaz para determinar el acceso quirúrgico en esta región.

Palabras clave:
Estudio en cadáveres
Quiasma óptico
Nervio óptico
Arteria carótida interna
Acceso quirúrgico

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