Extensions of the Sphenoid Sinus

Wang, Jian; Bidari, Sharatchandra; Inoue, Keiji; Yang, Hong; Rhoton, Albert L.

doi:10.1227/01.neu.0000367619.24800.b1

Cited by 194 publications

(201 citation statements)

References 41 publications

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“…The narrowest intercarotid distance was found to be either in the suprassellar segment 24 or at the level of the tuberculum sellae 25,26 . The mean values for the intercarotid distance at the selar region in healthy individuals reported in the literature have a wide range, varying from 12 mm to 18 mm 1,3,4,6,22,23,25,27,28,29 , what we believe to be related to the method used to measure the distance and the ethnical differences between the study populations.…”

Section: Discussionmentioning

confidence: 95%

Pituitary macroadenoma: analysis of intercarotid artery distance compared to controls

Nunes¹,

Cabral²,

Mello³

et al. 2016

Arq. Neuro-Psiquiatr.

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Despite all the improvement in transsphenoidal surgery, the anatomical knowledge has been a main issue stressed by most authors 1 . In the transsphenoidal approach for pituitary adenomas, detailed preoperative planning with information regarding the sphenoid sinus, tumoral involvement of adjacent structures (cavernous sinus, suprasellar region, carotid arteries) and intercarotid distance (ICD) is critical. Despite that, there is little literature regarding the ICD at the parassellar region of the intracranial carotid arteries at its cavernous segment and its modifications due to the sellar pathologies, specially non-functioning pituitary adenomas 2,3,4,5,6 .Although vascular injuries have become less frequent over the years, with reports ranging from 0-3.8% 7,8,9,10,11,12,13,14,15,16,17,18,19,20 , it is still considered one of the most important complications in the transsphenoidal approaches due to its potential hazardous effects and difficult management. Taking this into consideration, it is crucial that every surgeon knows exactly the carotid artery position and its relation to the lesion.This study has the aim to measure and analyze ICD in a series of patients with non-functioning pituitary adenomas with no previous treatment and correlate the data with measurements in controls with no endocrinological, sellar or parassellar disease. AbstrACtObjective: To evaluate the intercarotid distance (ICD) of patients with pituitary macroadenoma and compare to heatlhy controls. Method: We retrospectively reviewed contrast-enhanced MRI images from twenty consecutive patients diagnosed with non-functioning pituitary macroadenoma, measured the ICD at two different levels (petrous segment -ICD1 and horizontal cavernous segment -ICD2) and compared to twenty paired controls. Results: There was no statistically significant difference of the mean ICD1 between the groups and subgroups. For the ICD2 there was statistically significant difference between the case and controls. However, there was no significant difference between the patients with smaller adenomas and the controls. In contrast, the patients with giant adenomas showed statistically significantly higher ICD2 than the controls. Conclusion: The ICD at the horizontal segment of the cavernous carotid tends to be wider in patients with giant pituitary adenomas than in healthy individuals or patients with smaller adenomas.Keywords: Pituitary gland; pituitary disease; internal carotid artery; endoscopy; sella turcica. resumo Objetivo: Avaliar a distância intercarotídea (DIC) de pacientes com macroadenoma de hipófise e comparar com controles saudáveis. Método: Foram analisados retrospectivamente imagens de ressonância magnética com contraste de vinte pacientes consecutivos com diagnóstico de macroadenoma hipofisário não-funcionante, medidas as DIC em dois níveis diferentes (segmento petroso -DIC1 e segmento cavernoso horizontal -DIC2) e comparados com vinte controles pareados. Resultados: Não houve diferença estatisticamente significativa da DIC1 média entre os grupos e su...

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Section: Discussionmentioning

confidence: 95%

Pituitary macroadenoma: analysis of intercarotid artery distance compared to controls

Nunes¹,

Cabral²,

Mello³

et al. 2016

Arq. Neuro-Psiquiatr.

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“…For this reason, its degree of pneumatization is an important factor regarding these procedures, since the greater the pneumatization, the easier it is to identify the bony protuberances and depressions inside this sinus and to access surroundings structures and regions [10][11][12] . In addition to that, more anterior portions of the skull base are reached with a different trajectory, through the anterior and posterior ethmoidal cells.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic anatomy of the approaches to the sellar area and planum sphenoidale

Ramos

Monteiro

Pinheiro‐Neto

et al. 2011

Arq. Neuro-Psiquiatr.

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The productive work between otolaryngologists and neurosurgeons has resulted in the emergence of endoscopic endonasal skull base surgery. The goal of the present study is to describe the endoscopic anatomy of the endonasal approach to the sellar region and planum sphenoidale, highlighting the key points of the surgical approach and the neurovascular landmarks. Method: Descriptive study of the endoscopic endonasal dissection of 9 fresh cadavers with exposure of the anatomic structures. Results: The endoscopic endonasal ethmoidectomy and sphenoidotomy allows an expanded access to the sellar area and planum sphenoidale. The surface anatomy of the sphenoid sinus is easily identifiable and provides safe landmarks, guiding the intracranial dissection. Conclusion: The endoscopic endonasal approach to the skull base by the ENT and neurosurgeon is feasible, but it requires adequate anatomical knowledge and endoscopic skills for its realization, which can be obtained by practicing in cadavers. Key words: anatomy, skull base, endoscopic surgery, sphenoid sinus.Anatomia endoscópica do acesso à região selar e plano esfenoidal RESUMO O trabalho cooperativo entre otorrinolaringologistas e neurocirurgiões resultou no aprimo ramento das técnicas cirúrgicas e no surgimento da cirurgia endoscópica endonasal da base do crânio. O estudo tem como objetivo descrever a anatomia endoscópica do acesso endonasal da região selar e plano esfenoidal, destacando os pontos fundamentais do acesso cirúrgico e referências neurovasculares. Método: Estudo descritivo da dissecção endoscópica endonasal de 9 cadáveres frescos com exposição das estruturas anatômicas. Resultados: A etmoidectomia e esfenoidotomia endonasal endoscópica permite um acesso estendido à região selar e plano esfenoidal. A anatomia de superfície do seio esfenoidal é facilmente identificada e fornece pontos de referência seguros, guiando a dissecção intracraniana. Conclusão: O acesso endoscópico endonasal para a base do crânio pelo otorrinolaringologista e neurocirurgião é perfeitamente viável, mas para isso o conhecimento anatômico da região e de seus pontos de referência é essencial, o que pode ser obtido pelo treinamento em cadáveres. Palavras-chave: anatomia, base do crânio, procedimentos cirúrgicos endoscópicos, seio esfenoidal. CorrespondenceHenrique Faria Ramos Rua Capote Valente 188 / ap 91 05409-000 São Paulo SP -Brasil

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“…PP pneumatization is a very important surgical route for access to the middle part of the skull base without brain retraction. This route can be used in the endoscopic repair of the leak of cerebrospinal fluid and endoscopic biopsy of skull-base lesions [53].…”

Section: Pneumatization Of the Pterygoid Anterior Versus Posterior Cmentioning

confidence: 99%

CBCT Imaging of Paranasal Sinuses and Variations

Orhan¹,

Aksoy²,

Oz³

2017

Paranasal Sinuses

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Paranasal sinuses located in the bones surrounding the nasal cavity are called maxillary, ethmoid, frontal and sphenoid sinuses. In relation with their location, these sinuses contribute to the development of the facial structures, jaws and upper airway. During the developmental process of the paranasal sinuses, anatomic variations can occur in consequence of intra and extramural migration of the ethmoid air cells, overpneumatization or hypoplasia of the sinuses and bulging of the neurovascular structures to the sinuses. Some of these anatomic variations may affect the drainage pathways, pave the way for chronic infections and cause difficulties when performing paranasal sinuses surgery.Therefore, the aim of this chapter was to examine the paranasal sinus anatomic variations with cone beam computed tomography (CBCT).

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Extensions of the Sphenoid Sinus

Abstract: The variations in the extensions of pneumatization of the sphenoid sinus may facilitate entry into areas bordering the sphenoid sinus and play a role in the selection of a surgical approach to lesions bordering the sinus.

Cited by 194 publications

References 41 publications

Pituitary macroadenoma: analysis of intercarotid artery distance compared to controls

Pituitary macroadenoma: analysis of intercarotid artery distance compared to controls

Endoscopic anatomy of the approaches to the sellar area and planum sphenoidale

CBCT Imaging of Paranasal Sinuses and Variations

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