• Maria Peris-Celda, Baris Kucukyuruk, Alejandro Monroy-Sosa, Takeshi Funaki, Rowan Valentine, and Albert L Rhoton.
• Department of Neurosurgery, University of Florida, Gainesville, Florida.
• Neurosurgery. 2013 Dec 1; 73 (2 Suppl Operative): ons117-31; discussion ons131.

BackgroundThe sellar wall of the sphenoid sinus and its recesses have been previously studied, but their intracranial relationships to the diaphragma sellae, tuberculum, clinoid segment of the internal carotid artery, chiasmatic sulcus, and middle clinoid process need further definition.ObjectiveTo describe these intra- and extracranial relationships of the recesses in the anterior sellar wall.MethodsThe middle clinoid was studied in 132 parasellar areas of dry crania. Thirty-eight parasellar areas of formalin-fixed/silicone-colored specimens were dissected. After transsphenoidal endoscopic exposure, the optic, carotid, and sellar prominences; lateral opticocarotid and tuberculum recesses; and caroticosellar and medial opticocarotid points were identified. High-speed drills opened 1-mm perforations at these points to allow study of intracranial relationships.ResultsTwo recesses and 2 junction points can be recognized in the sphenoid sinus: lateral opticocarotid and tuberculum recesses and medial opticocarotid and caroticosellar points. The lateral opticocarotid recess corresponds to the optic strut base, and the clinoid segment of the internal carotid artery is located medially. The diaphragma sellae attachment is at the level of the tuberculum recess, which in 50% of cases corresponds to the tuberculum. A middle clinoid in base or height greater than 1.5 mm is present in 21.1% and a caroticoclinoid ring in 3%. The middle clinoid is 1 mm inferior and lateral to the caroticosellar point and 4.7 mm inferior to the medial opticocarotid point.ConclusionAn understanding of the intra- and extracranial relationships of the recesses of the sphenoid sinus will aid in accurately directing transsphenoidal approaches.

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