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Endoscopic Transsphenoidal View after Bone Removal

Surgical Correlation

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Combined suprasellar and transclival approaches. The pituitary gland and the ICA are exposed at the sellar and parasellar regions. The optic chiasm and nerves are located above the pituitary stalk. The superior hypophyseal arteries rise from the intradural segment of the ICA and gives branches to the optic nerves, the chiasm, and the pituiary stalk. The proximal dural ring surrounding the paraclinoid ICA was preserved on the left side. The inferior hypophyseal arteries rise from the cavernous ICA and runs to the posterior gland. In the lateral wall of the cavernous sinus the cavernous segment of the abducens nerve and V1 are observed. The V2 is located bellow the cavernous sinus and runs anteriorly. The sympathetic nerves ascend on the paraclival segment of the ICA gives branches to the sixth nerve and V1. The middle clivus is limited laterally by the paraclival and lacerum segments of the ICA, and the interdural segment of the abducens. The cisternal segment runs posteriorly to the anterior inferior cerebellar arteries (AICA) that rise from the basilar trunk. Note that the AICA crosses part of the nerve on the left side. (Image courtesy of JC Fernandez-Miranda)

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