ANATOMICAL VARIATIONS OF THE SPHENOID SINUS AND ADJACENT NEUROVASCULAR STRUCTURES
1Bakırçay Üniversitesi, Kulak Burun Boğaz Baş ve Boyun Cerrahisi, İzmir, Türkiye2SBÜ İzmir Bozyaka SUAM Eğitim Araştırma Hastanesi, Kulak Burun Boğaz Baş ve Boyun Cerrahisi, İzmir, Türkiye
3Özel Reyap Hastanesi, Kulak Burun Boğaz Baş ve Boyun Cerrahisi, İstanbul, Türkiye
4Özel Hekim, Kulak Burun Boğaz Baş ve Boyun Cerrahisi, Rize, Türkiye Objective: We aimed to evaluate the sphenoid sinus pneumatization, sphenoid sinus variations, internal carotid artery (ICA) dehiscence and protrusion, and the relationship between the optic nerve and maxillary sinus dehiscence and protrusions by evaluating the pre-operative computed tomography of the patients operated with the Endoscopic Endonasal Transsphenoidal Approach (EETSA).
Materials and Methods: The files of 113 patients who were operated on with EETSA, together with neurosurgery with a diagnosis of pituitary adenoma in our hospital between 2006 and 2015, were retrospectively analyzed.
Results: A total of 113 patients, 64 women and 49 men were included in the study. Sphenoid sinus pneumatization was found as 1.8% conchal, 7.3% presellar, 47.7% sellar and 43.3% postsellar type. While the postsellar type (44.8%) and the sellar type (44.8%) were equal in males, it was observed that the sellar type was the most common (50%) in females. Internal carotid artery (ICA) protrusion was 28.3%, and dehiscence was 2.65%. ICA protrusion was found to be higher in men than in women (p = 0.008). In our study, it was determined that the optic nerve protrusion was 25.6%, and the optic nerve dehiscence was 1.76%. While the protrusion of the maxillary nerve was generally 25.9%, the dehiscence of the maxillary nerve was generally 7.4%. Clinoid pneumatization was 27% in men and 14.1% in women. The difference was statistically significant (p <0.005). Sphenoid interseptum terminated on the left internal carotid artery in 25 patients (22%), while it was found to end on the right internal carotid artery in 13 patients (11.5%). While it was observed to end on sella turcica in 54 patients (47.7%), there was no septum in 3 patients (2.65%).
Conclusion: The data of our study revealed that the anatomy of the sphenoid sinus showed a significant change. It is crucial to examine routine preoperative CT findings in detail by the surgical team to minimize complications by providing safe access to the sella while approaching the skull base with the endonasal transsphenoidal corridor.
Keywords : Endoscopic pituitary surgery, sphenoid sinus, transsphenoidal approach