0:01

We're talking sagittal anatomy of the

0:02

pituitary gland here at MRI Online.

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We've got the posterior lobe of the pituitary,

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known as the neurohypophysis.

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It consists of an infundibular stalk,

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which is a little fatter up top, as we'll see.

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We've got the median eminence of the hypothalamus here,

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then the stalk, and then the pars nervosa in the

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back with the posterior pituitary bright spot,

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which contains proteinaceous secretory cells.

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Then we have the anterior lobe, or the adenohypophysis.

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So neurohypophysis, adenohypophysis,

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it has three components.

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This little bump right here,

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down at the base of the

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stalk between the stalk and the pars distalis,

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known as the pars tuberalis.

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Then we've got the pars distalis,

0:50

which is the anterior pituitary gland.

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And then in between,

0:53

you can sort of see it as a slight alteration in signal

0:57

the pars intermedia, which is where some cysts.

1:00

Some pars intermedia cysts may form.

1:03

Now, we've also got a pre cellar region

1:05

or an anterior cellar region,

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that consists of some important bony anatomy.

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I'm going to turn over to Dr. Shupack in a minute.

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We've got the suprasellar region that consists of the

1:14

optic chiasm and you can follow the optic chiasm,

1:16

watch it as it goes towards the optic neural foramen,

1:20

which is absolutely critical.

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And right next to it,

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we have the carotid artery and the carotid siphon.

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Dr. Schupack's area of expertise for sure.

1:28

And then the retrosellar region,

1:30

which consists of the posterior clinoids and the clivus.

1:34

So, Dr. Schupack,

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can you talk a little bit about the bony anatomy

1:38

anteriorly and maybe just briefly, the sphenoid.

1:40

Right.

1:41

So, you know,

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if we're talking about pituitary surgery,

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which is the indication or the thought, at least,

1:47

of a lot of clinicians.

1:48

There's two reasons, right?

1:50

An endocrine,

1:51

which is some of the cases,

1:52

but most of them have to do with mass effect,

1:54

and we're going to see cases of that.

1:56

So, mass effect on what?

1:57

All right, so what's around it?

2:00

Dr. Pomeranz already talked about this guy,

2:03

which would be the carotids.

2:04

Okay? So that's going to be an important consideration.

2:08

Now,

2:09

the optic apparatus is probably going to be the thing

2:12

that's going to bring a large percentage of pituitaries

2:15

that have surgery to light

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because of visual field defects.

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So you can see the relationship there

2:20

of a suprasellar mass.

2:21

Okay?

2:22

And going right into the optic canal.

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Now, the other thing that's going to be very

2:26

helpful to us is these parasellar areas.

2:29

So this is the tuberculum sellae.

2:31

Okay?

2:32

Tuberculum sellae.

2:33

And then more anteriorly,

2:35

the olfactory groove. Okay?

2:37

The planum sphenoidale is here.

2:39

But...

2:40

So, it goes tuberculum planum, olfactory groove.

2:43

Olfactory groove, anteriorly.

2:45

But these are common causes for other

2:46

lesions that may affect the sella,

2:48

such as meningiomas.

2:49

Okay.

2:50

Tuberculum meningioma is going to be

2:52

in your differential and it's going

2:54

to be a very important one.

2:55

So, it's all about the relations and the other structures

2:59

if you're going to really talk about pituitary.

3:02

Well, we'll drill into the sphenoid sinus,

3:04

because I know that's a very important

3:06

area for you as a surgeon.

3:07

We'll talk more about it in the coronal projection,

3:09

shall we?

3:09

Correct.

3:10

Great.