Surgical anatomy of the superior hypophyseal artery and its relevance for endoscopic endonasal surgery

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OBJECTIVE

The endoscopic endonasal approach has become a routine corridor to the suprasellar region. The superior hypophyseal arteries (SHAs) are intimately related to lesions in the suprasellar space, such as craniopharyngiomas and meningiomas. Here the authors investigate the surgical anatomy and variations of the SHA from the endoscopic endonasal perspective.

METHODS

Thirty anatomical specimens with vascular injection were used for endoscopic endonasal dissection. The number of SHAs and their origin, course, branching, anastomoses, and areas of supply were collected and analyzed.

RESULTS

A total of 110 SHAs arising from 60 internal carotid arteries (ICAs), or 1.83 SHAs per ICA (range 0–3), were found. The most proximal SHA always ran in the preinfundibular space and provided the major blood supply to the infundibulum, optic chiasm, and proximal optic nerve; it was defined as the primary SHA (pSHA). The more distal SHA(s), present in 78.3% of sides, ran in the retroinfundibular space and supplied the stalk and may also supply the tuber cinereum and optic tracts. In the two sides (3.3%) in which no SHA was present, the territory was covered by a pair of infundibular arteries originating from the posterior communicating artery. Two-thirds of the pSHAs originated proximal to the distal dural ring; half of these arose from the carotid cave portion of the ICA, whereas the other half originated proximal to the cave. Four branching patterns of the pSHA were recognized, with the most common pattern (41.7%) consisting of three or more branches with a tree-like pattern. Descending branches were absent in 25% of cases. Preinfundibular anastomoses between pSHAs were found in all specimens. Anastomoses between the pSHA and the secondary SHA (sSHA) or the infundibular arteries were found in 75% cases.

CONCLUSIONS

The first SHA almost always supplies the infundibulum, optic chiasm, and proximal optic nerve and represents the pSHA. Compromising this artery can cause a visual deficit. Unilateral injury to the pSHA is less likely to cause an endocrine deficit given the artery’s abundant anastomoses. A detailed understanding of the surgical anatomy of the SHA and its many variations may help surgeons when approaching challenging lesions in the suprasellar region.

ABBREVIATIONS DDR = distal dural ring; ICA = internal carotid artery; ICG = indocyanine green; PCoA = posterior communicating artery; pSHA = primary SHA; SHA = superior hypophyseal artery; sSHA = secondary SHA.

Article Information

Correspondence Juan C. Fernandez-Miranda: University of Pittsburgh Medical Center, Pittsburgh, PA. fernandezmirandajc@upmc.edu.

INCLUDE WHEN CITING Published online July 13, 2018; DOI: 10.3171/2018.2.JNS172959.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Origin and pattern of the superior hypophyseal artery (SHA). A: The primary SHA (pSHA) originates from the clinoidal segment of the ICA (yellow arrow), proximal to the carotid cave, demonstrated by the black plastic, and runs in the preinfundibular space. The secondary SHA (sSHA) can be seen running toward the posterior part of the infundibulum. B: The pSHA with a carotid cave origin (yellow arrow) and the cavernous sinus ophthalmic artery. C: The pSHA (yellow arrow) branches off from the ophthalmic segment of the ICA. D: Infundibular artery, considered as a variant of the pSHA in this study (see text), arises from the PCoA on the left side (yellow arrow) and runs to the preinfundibular area whose supplying territory is similar to a pSHA. On the right, the first two SHAs take off as a common trunk at the ophthalmic segment of the ICA. art. = artery; Infund. = infundibular; Ophth. = ophthalmic; PComA = posterior communicating artery. Copyright Juan C. Fernandez-Miranda. Published with permission. Figure is available in color online only.

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    A: Types of branching of the pSHA: infundibular, optic, and descending. B: Pattern of branching: candelabra-like type, where the three major branches are taking off from the main trunk at approximately the same point. C: Pattern of branching: tree-like or early optic-branching type, four optic branches can be seen alternatingly branching off the pSHA before two infundibular branches. A descending branch comes off a larger infundibular branch. D: Pattern of branching: no-descending type, on the left side, only two optic and one infundibular branch can be seen; there is no descending from the left pSHA. E: Pattern of branching: no-optic type, right pSHA shows a descending branch and an infundibular branch with no branch to the optic nerve. Of note, abundant supply can be seen originating from the anterior communicating complex. br. = branch; Infund. = infundibular. Copyright Juan C. Fernandez-Miranda. Published with permission. Figure is available in color online only.

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    Descending branch and dural feeding. A: Two descending branches reach the anterior lobe of the pituitary gland and course back to the junction of the gland and the stalk to supply both. B: Descending branch feeding the diaphragm dura. C: The descending branch from the right side feeds both the dura and the gland. D: A small vessel branching off the right optic branch, piercing the arachnoid membrane to reach and feed the prechiasmatic sulcus dura. br. = branch. Copyright Juan C. Fernandez-Miranda. Published with permission. Figure is available in color online only.

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    Artistic illustration of branching patterns of SHA. A: Type A, the candelabra-like type, is illustrated on the right side, and type B, the tree-like or early optic-branching type, is on the left. B: Type C, the no-descending type, is on the right side, and type D, the no-optic type, is on the left. Copyright Juan C. Fernandez-Miranda. Published with permission. Figure is available in color online only.

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    Anastomoses of SHA. A: Preinfundibular anastomosis, a prominent side-to-side anastomosis of the two pSHAs. The right pSHA appears to be significantly dominant to the left one. B: The anastomosis between the pSHA and sSHA of the same side and that between posterior SHA and perforators from the PCoA help to reinforce the preinfundibular anastomosis and comprise the circuminfundibular anastomosis. C: Retroinfundibular anastomosis between sSHA and perforator from the PCoA. D: A descending branch, in this case from the sSHA, pierces through the diaphragm to connect to a branch from the inferior hypophyseal artery (IHA) to form an extrahypophyseal SHA-IHA anastomosis. anas. = anastomosis; br. = branch; Pre-infund. = preinfundibular. Copyright Juan C. Fernandez-Miranda. Published with permission. Figure is available in color online only.

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    Intraoperative visualization of SHA. Case 1. Descending branch tightly adhered to tumor (A). After sacrificing the descending branch, the optic chiasm could be dissected up, and more space was created to dissect the tumor (B). Case 2. After initial debulking, the SHA could be seen to be displaced posteriorly by the tumor (C). Well-preserved SHA and branches (D). Case 3. Well-preserved SHA on the right (E) and left (F). br. = branch; Des. = descending; Inf. = infundibular; Opt. = optic; PS = pituitary stalk. Figure is available in color online only.

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