Persisting embryonal infundibular recess

Case report

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Persisting embryonal infundibular recess (PEIR) is a rare anomaly of the third ventricular floor that has an unclear pathogenesis. In all 7 previously described cases, PEIR was present in adult patients and was invariably associated with hydrocephalus and, in 4 reported cases, with an empty sella. These associated findings led to speculations about the role of increased intraventricular pressure in the development of PEIR.

In the present case, PEIR was found in a 24-year-old man without the presence of hydrocephalus or empty sella. Disorders of pituitary function had been present since childhood. Magnetic resonance imaging revealed a cystic expansion in an enlarged sella turcica. A communication between the third ventricle and the sellar cyst was suspected but not apparent. During transcranial surgery, the connection was confirmed. Later, higher-quality MR imaging investigations clearly showed a communication between the third ventricle and the sellar cyst through a channel in the tubular pituitary stalk. This observation and knowledge about the embryology of this region suggests that PEIR may be a developmental anomaly caused by failure of obliteration of the distal part of primary embryonal diencephalic evagination. Thus, PEIR is an extension of the third ventricular cavity into the sella.

Although PEIR is a rare anomaly, it is important to identify when planning a procedure on cystic lesions of the sella. Because attempts at removal using the transsphenoidal approach would lead to a communication between the third ventricle and the nasal cavity, a watertight reconstruction of the sellar floor is necessary.

Abbreviation used in this paper: PEIR = persisting embryonal infundibular recess.

Article Information

Address correspondence to: Andrej Šteňo, M.D., Department of Neurosurgery, Comenius University School of Medicine, Derer's Hospital, Limbova 5, 833 05 Bratislava, Slovakia. email: andrej.steno@gmail.com.

© AANS, except where prohibited by US copyright law.

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Figures

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    Sagittal (upper) and coronal (lower) T1-weighted MR images showing the communication between the third ventricle and the cystic formation within the enlarged sella through a channel in the tubular pituitary stalk.

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    Sagittal T2-weighted MR image showing PEIR forming an intrasellar cyst. The sella is enlarged with markedly expanded sellar floor.

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    Schematic drawings of the malformation based on ventriculograms (A–D) and MR images (E and F) in previously reported cases by Kuhne and Schwartz (A), Cabanes (B), Schumacher and Gilsbach (C), Vallee et al., (D), Morota et al. (2 cases with similar MR imaging findings were reported; E), and Iplikcioglu et al. (F).

References

  • 1

    Cabanes J: Asymptomatic persistence of infundibularis recessus. Case report. J Neurosurg 49:7697721978

  • 2

    Collins PDevelopment of the nervous system. Standring S: Gray's Anatomy ed 39EdinburghElsevier-Churchill-Livingstone2005. 241274

    • Search Google Scholar
    • Export Citation
  • 3

    Corrales MTorrealba G: The third ventricle. Normal anatomy and changes in some pathological conditions. Neuroradiology 11:2712771976

    • Search Google Scholar
    • Export Citation
  • 4

    Diepen RDer Hypothalamus. von Moellendorff WBargmann W: Handbuch des mikroskopischen Anatomie des Menschen. Nervensystem Vol 7:BerlinSpringer-Verlag1962. 1525

    • Search Google Scholar
    • Export Citation
  • 5

    Dyson MPituitary gland. Williams PL: Gray's Anatomy ed 38New YorkChurchill Livingstone1995. 18831888

  • 6

    Iplikcioglu ACBek SGokduman CADinc CCosar M: Primary empty sella syndrome associated with dilated infundibular recessus. J Neurol Sci 21:1271302004

    • Search Google Scholar
    • Export Citation
  • 7

    Kaufman BTomsak RLKaufman BAArafah BUBellon EMSelman WR: Herniation of the suprasellar visual system and third ventricle into empty sellae: morphologic and clinical considerations. AJR Am J Roentgenol 152:5976081989

    • Search Google Scholar
    • Export Citation
  • 8

    Kier ELComparative anatomy of the third ventricular region. Apuzzo ML: Surgery of the Third Ventricle ed 2BaltimoreWilliams & Wilkins1998. 4345

    • Search Google Scholar
    • Export Citation
  • 9

    Kuhne DSchwartz RB: Persisting intrapituitary recessus infundibuli. Neuroradiology 10:1771781975

  • 10

    Larsen WJDevelopment of the brain and cranial nerves. Larsen WJ: Human Embryology ed 2New YorkChurchill Livingstone1997. 411454

    • Search Google Scholar
    • Export Citation
  • 11

    Morota NWatabe TInukai THongo KNakagawa H: Anatomical variants in the floor of the third ventricle; implications for endoscopic third ventriculostomy. J Neurol Neurosurg Psychiatry 69:5315342000

    • Search Google Scholar
    • Export Citation
  • 12

    Rhoton AL JrThe lateral and third ventricles. Rhoton AL Jr: Cranial Anatomy and Surgical Approaches BaltimoreLippincott Williams & Wilkins2003. 235299

    • Search Google Scholar
    • Export Citation
  • 13

    Schumacher MGilsbach J: A new variety of “empty sella” with cystic intrasellar dilatation of the recessus infundibuli. Br J Radiol 52:8628641979

    • Search Google Scholar
    • Export Citation
  • 14

    Standring SCrossman ARDiencephalon. Standring S: Gray's Anatomy ed 39EdinburghElsevier-Churchill-Livingstone2005. 369385

  • 15

    Vallee BBesson GPerson HMimassi N: Persisting recessus infundibuli and empty sella. J Neurosurg 57:4104121982

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