+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Anatomic Variations of the Sphenoid Sinus and Their Impact on Trans-sphenoid Pituitary Surgery



Anatomic Variations of the Sphenoid Sinus and Their Impact on Trans-sphenoid Pituitary Surgery



Skull Base 18(1): 9-15



The trans-sphenoid access to the pituitary gland is becoming the most common approach for pituitary adenomas. Preoperative evaluation of the anatomy of the sphenoid sinus by computed tomography (CT) scan and magnetic resonance imaging (MRI) is a routine procedure and can direct the surgical decision. This work determines the incidence of the different anatomical variations of the sphenoid sinus as detected by MRI and CT scan and their impact on the approach. The CT scan and MRI of 296 patients operated for pituitary adenomas via a trans-sphenoid approach were retrospectively reviewed regarding the different anatomical variations of the sphenoid sinus: degree of pneumatization, sellar configuration, septation pattern, and the intercarotid distance. There were 6 cases with conchal pneumatization, 62 patients with presellar, 162 patients with sellar, and 66 patients with postsellar pneumatization. There was sellar bulge in 232 patients, whereas this bulge was absent in 64 patients. There was no intersphenoid sinus septum in 32 patients, a single intersphenoid septum in 212 patients, and an accessory septum in 32 patients. Intraoperatively, the sellar bulge was marked in 189 cases and was mild in 43 cases. The pattern of pneumatization of the sphenoid sinus significantly affects the safe access to the sella. A highly pneumatized sphenoid sinus may distort the anatomic configuration, so in these cases it is extremely important to be aware of the midline when opening the sella to avoid accidental injury to the carotid and optic nerves. The sellar bulge is considered one of the most important surgical landmarks, facilitating the access to the sella. The surgical position of the patient is also a crucial point to avoid superior or posterior misdirection with resultant complications. It is wise to use extreme caution while removing the terminal septum. Different anatomical configurations of the sphenoid sinus can seriously affect the access to the sella via the nose. The surgeon should be aware of these findings preoperatively to reach the sella safely and effectively.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 051537841

Download citation: RISBibTeXText

PMID: 18592020

DOI: 10.1055/s-2007-992764


Related references

Variations in the sella turcica, the body of the sphenoid and the sphenoid sinus as a function of variations in the sphenoid angle. Acta Anatomica 44: 354-362, 1961

Variations of the selle turcica, sphenoid body and the sphenoid sinus as a function of the variations of the sphenoid angle. Acta Anat 44(4): 354-362, 1961

Risky anatomic variations of sphenoid sinus for surgery. Surgical and Radiologic Anatomy 28(2): 195-201, 2006

Sphenoid Sinus: Anatomic Study, With Consideration Of The Clinical Significance Of The Structural Characteristics Of The Sphenoid Sinus. Archives of Otolaryngology - Head and Neck Surgery 34(2): 225-253, 1941

Sphenoid sinus septations: unpredictable anatomic landmarks in endoscopic pituitary surgery. Journal of Otolaryngology - Head and Neck Surgery 40(6): 489-492, 2011

Sphenoid sinus aspergilloma in trans-sphenoidal surgery for pituitary adenomas. Acta Neurochirurgica 157(8): 1345, 2015

Treatment of isolated sphenoid sinus disease by trans-basal lamella approach to sphenoid sinus. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 30(16): 1317-1319, 2016

MRI appearances of the sphenoid sinus at the late follow-up of trans-sphenoidal surgery for pituitary macroadenoma. Australasian Radiology 46(1): 33-40, 2002

Transpterygoid Trans-sphenoid Approach to the Lateral Extension of the Sphenoid Sinus to Repair a Spontaneous CSF Leak. Skull Base 16(4): 207-212, 2006

The anatomical relations of the sphenoid sinus and their implications in sphenoid endoscopic surgery. Romanian Journal of Morphology and Embryology 54(1): 13-16, 2013

Anatomic variations of the sphenoid sinus on computed tomography. Rhinology 43(2): 109-114, 2005

Assessment of sphenoid sinus related anatomic variations with computed tomography. Pan African Medical Journal 27: 109, 2017

Trans septal approach to the sphenoid sinus and the pituitary gland. Otolaryngology 54(2): 141-148, 1982

An Analysis of Anatomic Variations of the Sphenoid Sinus and Its Relationship to the Internal Carotid Artery. International Archives of Otorhinolaryngology 22(2): 161-166, 2018

Anatomic variations of the septation within the sphenoid sinus on CT scan images--an initial report. Przeglad Lekarski 67(4): 279-283, 2010