Tag: Sphenoid Sinus

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Utility of the Vidian Canal in Endoscopic Skull Base Surgery: Detailed Anatomy and Relationship to the Internal Carotid Artery

World Neurosurg. (2019) 121:e140-e146

OBJECTIVE: To investigate key anatomic features of the vidian canal that have a critical role in planning and performing endoscopic skull base surgeries.

METHODS: We reviewed skull base computed tomographic images of 640 consecutive subjects. Studies were analyzed in axial, coronal and sagittal planes. –

RESULTS: The mean (SD) length of the vidian canal was 15.4±2.0 mm in female subjects and 16.6±1.7 mm in male subjects, and the difference between genders was statistically significant (P < 0.001). The most common rostral-caudal course of the vidian canal was medial to lateral and was followed by the straight course, tortuous course, and lateral-to-medial course. The frequency of pneumatization pattern from most common to least common was types 0, III, II and I. Of 342 evaluated sides, the vidian canal was located below the level of the anterior genu of petrous ICA in 303 (89%) sides, at same level with the anterior genu of petrous ICA in twenty-five(7%) sides, and above the level of the anterior genu of petrous ICA in fourteen(4.1%) sides.

CONCLUSIONS: A variety of previously undefined features of the vidian canal that can alter the course of surgical procedure were defined. The position of the vidian canal with respect to the petrous internal carotid artery (ICA) was extensively described. From a surgical standpoint, a working room inferior and medial to the vidian canal might not always be a safe approach, because the vidian canal could be located superior to the level of the anterior genu of petrous ICA according to our findings in the present study.

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Sphenoid sinus anatomy and suprasellar extension of pituitary tumors

Sphenoid sinus anatomy

J Neurosurg 119:669–674, 2013

As tumors enlarge, they generally grow along paths of least resistance. For pituitary macroadenomas, extrasellar extension into the suprasellar region, cavernous sinus, or sphenoid sinus may occur. The sphenoid sinus is known to have a variable anatomical configuration, and the authors hypothesize that certain anatomical factors may resist tumor expansion into the sphenoid sinus, thereby directing tumor growth into the suprasellar space. In this paper the authors’ goal was to determine if sphenoid anatomy influences pituitary tumor growth.

Methods. The authors conducted a retrospective analysis of 106 consecutive surgical cases of pituitary macroadenoma. Patient demographics, suprasellar extension, sellar width, and features of the sphenoid intersinus septum were recorded on radiographic review. The chi-square test, t-test, logistic regression, and classification and regression tree analysis were used for statistical analysis.

Results. Of the 106 patients included in the study, 71 (67%) demonstrated suprasellar extension of their tumor. Patients with suprasellar tumor extension had significantly greater intersinus septum width (width > 1.27 mm: OR = 14.32; p = 0.0012) and were significantly older (age > 54 yrs: OR = 3.33; p = 0.0176). They also tended to be male and to have two or more sphenoid partitions (OR = 6.58; p = 0.0306). While patients with suprasellar extension tended to be more likely to have a midline partition and a larger sellar width than their counterparts, these differences did not reach statistical significance.

Conclusions. Certain aspects of the sphenoid sinus anatomy may function to resist pituitary tumor growth into the sphenoid sinus. Progressive enlargement of pituitary macroadenomas may extend in a suprasellar direction, in part, as a consequence of the sphenoid sinus anatomy.

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Transphenoidal surgery in acromegalic patients: anatomical considerations and potential pitfalls

Transphenoidal surgery in acromegalic patients- anatomical considerations and potential pitfalls.1 Transphenoidal surgery in acromegalic patients- anatomical considerations and potential pitfalls

Acta Neurochir (2013) 155:125–130

Transphenoidal surgery is an effective treatment for acromegalic patients with growth hormone (GH) producing pituitary adenomas. Since acromegaly is a systemic disease which causes multiple bony alterations, we hypothesized that it could affect the sphenoid sinus anatomy. The aim of the study was to determine whether acromegalic patients have sphenoid sinus alterations with potential surgical impact.

Methods Fourty-six consecutive patients (23 acromegalics- GH group, 23 non-acromegalics-nGH group) undergoing transphenoidal surgery were included in this study. Preoperative volumetric CT scan of the head was used to assess the following anatomic characteristics: type of sphenoid sinus (sellar, pre-sellar, conchal); number of intrasphenoid septa; number of carotid-directed septa; intercarotid distance; depth of the sphenoid sinus; depth and size of the sella.

Results The sphenoid sinus was of the pre-sellar/conchal type in 26 % of the patients with acromegaly (n023) versus 9 % of the patients of the nGH group (n023). The number of intrasphenoid septations was significantly higher in the GH group than in the nGH group (P=.03). Interestingly, the intercarotid distance was smaller in GH patients than in nGH displaying a trend toward significance (P=.05). The sphenoid bone was deeper in the GH group as compared to the nGH group (P=.01) but the distance sphenoid sinus-sella was reduced (P<.01). Finally, the sella was not deeper, nor larger in acromegalic patients.

Conclusions The sphenoid sinus of acromegalic patients resulted in being deeper, characterized by more septa and by a reduced intercarotid distance. These alterations deserve special pre- and intraoperative care, being potentially responsible for surgical difficulties.

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