The Intersphenoid Sinus Septum: An Impractical Anatomic Landmark in Transsphenoidal Endoscopic Pituitary Surgery

Poirier, Justin; Lee, Donald; Duggal, Neil; Rotenberg, Brian

doi:10.1055/s-2011-1274241

Cited by 5 publications

(6 citation statements)

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“…In our paper and in those we reviewed, usually only one ICA protuberance had an interconnection with the septum. In the paper of Poirier et al both ICAs were involved in 3.4% of the cases, which is a lower rate when compared with the our material, 14% [12]. In none of our cases, and in those we reviewed only one ICA had a connection with more than one septum.…”

Section: Discussioncontrasting

confidence: 60%

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Sphenoid sinus septations and their interconnections with parasphenoidal internal carotid artery protuberance: radioanatomical study with literature review.

Dziedzic

Koczyk

Gotlib

et al. 2019

Videosurgery and Other Miniinvasive Techniques

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Introduction: Internal carotid artery (ICA) injury is the most dangerous and life-threatening complication in patients operated on due to parasellar tumors via a minimally invasive endoscopic endonasal approach. Sphenoid septal attachment to the ICA protuberance within the sphenoid sinus was found to be one of the anatomical risk factors for ICA injury during transsphenoidal surgery. Aim: To determine the relationship between the sphenoid sinus septa and the parasellar or paraclival internal carotid artery prominence based on our own material and a literature review. Material and methods: The axial plane scans of computed tomography angiography and a literature review of previously published papers on the septum variation and its connection with the ICA prominence are provided. Results: Out of 100 sphenoid sinuses, 49 (49%) had at least one septum inserted at the ICA prominence. In the majority of cases 42 (86%) one septum was inserted at the prominence of one of the ICAs. In 7 (14%) cases, two separate septa were inserted at the prominences of both ICAs. Patients with multiple septa and those having an incomplete septum were at higher risk of at least one of them being inserted at the ICA prominence within the sinus. Including cases from the literature review, the average number of septa per patient was 1.42. The risk of intersection between the septum and the ICA prominence was 32%. Conclusions: A significant percentage of the intrasphenoidal septa are inserted at the sphenoidal ICA protuberance.

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Section: Discussioncontrasting

confidence: 60%

“…There were two purely anatomical [8,9], 5 radiological [4, 10-13] and 3 combining those two methods of assessment [3,4,14]. There were studies which included patients with [4,11,12] or without [3, 8-10, 13, 14] pathology within or in proximity to the sphenoid sinus. A summary of all the studies is presented in Table I.…”

Section: Methodsmentioning

confidence: 99%

Sphenoid sinus septations and their interconnections with parasphenoidal internal carotid artery protuberance: radioanatomical study with literature review.

Dziedzic

Koczyk

Gotlib

et al. 2019

Videosurgery and Other Miniinvasive Techniques

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“…Insertion of the septum on the walls of the ACI and the optic nerve should raise concerns about damage to its structures during manipulation of the septum, which should be done with caution [16,27,28]. The results of the present study are in agreement with Poirier [29] who found that the septum was inserted in 16% of the cases on the wall of the ACI, Kapur [30], who found 14%, and Cappabianca [31], which found 26%. ELkammash [1] found that the septum was present in 86.8% of cases, it was unique and complete in 70% of cases and its insertion was done in 19.8% on the walls of the CIA (right 36.8 %, left 63.2%); the extend into anterior clinoid processes, with pneumatization of these structures in 6% -13% of cases [16,27].…”

Section: Discussionsupporting

confidence: 89%

Radioanatomical Features of the Sphenoid Sinus in the Ivorian Population

BROALET¹,

Renaud²,

Ouattara³

et al. 2022

IJAR

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Background and purpose: The sphenoid sinus is characterized by the frequency of anatomical variants that cause operative difficulties and complications during the transphenoidal approach. These variants involve the geographic factor and the type of skin phenotype. Most of the studies have been carried out on European, North African and Asian populations. Some studies have been found in sub-Saharan Africa but not in Côte d’Ivoire. The aim was to determine, from CT data, the anatomical characteristics of the sphenoid sinus in the Ivorian population. Methods: Cranioencephalic computed tomography images of 100 patients (80 men and 20 women aged 16 to 71) were used for the study. These were patients who presented with head trauma without injury to the base of the skull. Were studied the anatomical characteristics of the sphenoid sinus. Results: The type of pneumatization was sellar in 58% sinuses, pre sellar in 41% and conchal in 1% of cases. The presellar type predominated in women (60%) and the sellar type in men (65.5%). Extensions were present in 66.34% of cases, more frequent in men (70%), in the sellar type (79.31%), and in the anterior clinoid process (46.20%). The procidence of vasculo-nervous structures was more frequent in men (52.62%) and in the sellar type (62.07%), the procidence of the internal carotid artery was bilateral in 30.69% of sinuses, that of the optic nerve was mainly unilateral left (07.92%) more frequent in women ( 10%) and in the sellaire type (09.43%). Dehiscence was present in 15% of cases. Dominance was straight in 63.64% of the sinuses. The Onodi cell was present in 65% of sinuses. The ostium was bilateral in (45%) of the sinuses. Conclusion: The Ivorian sphenoid sinus is highly pneumatized, facilitating access to the surgeon; the sellar type is the most frequent. On the other hand, the frequency of procidence and dehiscence of vasculo-nervous elements increases the risk of surgical complications. Differences between genders and between types of pneumatization should be considered in sphenoid sinus procedures. KEY WORDS: Sphenoid Sinus, Computed Tomography, Anatomic Variation, Ivorian. Background and purpose: The sphenoid sinus is characterized by the frequency of anatomical variants that cause operative difficulties and complications during the transphenoidal approach. These variants involve the geographic factor and the type of skin phenotype. Most of the studies have been carried out on European, North African and Asian populations. Some studies have been found in sub-Saharan Africa but not in Côte d’Ivoire. The aim was to determine, from CT data, the anatomical characteristics of the sphenoid sinus in the Ivorian population. Methods: Cranioencephalic computed tomography images of 100 patients (80 men and 20 women aged 16 to 71) were used for the study. These were patients who presented with head trauma without injury to the base of the skull. Were studied the anatomical characteristics of the sphenoid sinus. Results: The type of pneumatization was sellar in 58% sinuses, pre sellar in 41% and conchal in 1% of cases. The presellar type predominated in women (60%) and the sellar type in men (65.5%). Extensions were present in 66.34% of cases, more frequent in men (70%), in the sellar type (79.31%), and in the anterior clinoid process (46.20%). The procidence of vasculo-nervous structures was more frequent in men (52.62%) and in the sellar type (62.07%), the procidence of the internal carotid artery was bilateral in 30.69% of sinuses, that of the optic nerve was mainly unilateral left (07.92%) more frequent in women ( 10%) and in the sellaire type (09.43%). Dehiscence was present in 15% of cases. Dominance was straight in 63.64% of the sinuses. The Onodi cell was present in 65% of sinuses. The ostium was bilateral in (45%) of the sinuses. Conclusion: The Ivorian sphenoid sinus is highly pneumatized, facilitating access to the surgeon; the sellar type is the most frequent. On the other hand, the frequency of procidence and dehiscence of vasculo-nervous elements increases the risk of surgical complications. Differences between genders and between types of pneumatization should be considered in sphenoid sinus procedures. KEY WORDS: Sphenoid Sinus, Computed Tomography, Anatomic Variation, Ivorian.

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“…Therefore, identifying the artery is crucial to keep a safe distance during tumor resection. 9 18 19 20 …”

Section: Discussionmentioning

confidence: 99%

An Analysis of Anatomic Variations of the Sphenoid Sinus and Its Relationship to the Internal Carotid Artery

Secchi

Dolci

Teixeira

et al. 2017

Int Arch Otorhinolaryngol

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Introduction The sphenoid sinus (SS) has a high variability; its anatomical relations and variations must be well understood prior to the expanded endoscopic surgery (EES) at the skull base via the endonasal transsphenoidal approach. A feared complication is injury to the internal carotid artery (ICA). Objective To evaluate the anatomic variations of the SS and its relationship to the ICA using computed tomography (CT). Methods Cross-sectional retrospective study. Analysis of 90 patients' CT scans on axial, coronal and sagittal planes with 1 mm slices, evaluating lateral and posterior extensions of pneumatization of the SS, deviation of the sphenoid septum, presence of septations and their relationship to the parasellar and paraclival segments of the internal carotid artery (psICA and pcICA, respectively). Results The association between the protrusions of the psICA and the pcICA was statistically significant ( p < 0.001), as was the association between the lateral extension of pneumatization of the SS and the protrusion of the psICA ( p = 0.014). The presence of the posterior extension of pneumatization of the SS and protrusion of the pcICA occurred in 46% of the cases. Deviation of the sphenoid septum in the direction of the pcICA was present in 14% and dehiscence of the pcICA was seen in 3.6% of the cases. Conclusion Using the CT scan to recognize the type of extensions of pneumatization of the SS, the deviation of the sphenoid septum, and the presence of septations is beneficial to identify accurately the ICA and to reduce the risk of injury to it.

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The Intersphenoid Sinus Septum: An Impractical Anatomic Landmark in Transsphenoidal Endoscopic Pituitary Surgery

Cited by 5 publications

References 0 publications

Sphenoid sinus septations and their interconnections with parasphenoidal internal carotid artery protuberance: radioanatomical study with literature review.

Sphenoid sinus septations and their interconnections with parasphenoidal internal carotid artery protuberance: radioanatomical study with literature review.

Radioanatomical Features of the Sphenoid Sinus in the Ivorian Population

An Analysis of Anatomic Variations of the Sphenoid Sinus and Its Relationship to the Internal Carotid Artery

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