Medical Journal of Dr. D.Y. Patil Vidyapeeth (Jan 2023)
Assessment of computed tomography-based sphenoidal and sellar parameters relevant to transsphenoidal approach in sellar and parasellar surgeries
Abstract
Aim: To study the sphenoid and sellar parameters relevant to transsphenoidal approach in sellar and parasellar surgeries. Objectives: (1) To estimate the types of pneumatization of sphenoid sinus and intersphenoidal septum, (2) To assess the attachment and number of intersphenoidal septum among those who have intersphenoidal septum, (3) To determine the thickness of the anterior wall and floor of sella, and (4) To calculate the intercarotid distance of the intracavernous internal carotid artery. Methods: This was a record-based descriptive study. All retrospective computed tomographic (CT) images of head (demonstrating the nasal cavities, sphenoid sinus, and sella) done in the department of radiodiagnosis, using Toshiba Aquilon Prime 160 slice CT scanner, during the period of September 2016–February 2017 for routine diagnostic purpose were included. Following parameters were assessed: The pneumatization pattern of the sphenoid sinus, septation within the sphenoid sinus, intercarotid distance, thickness of the bony anterior sellar wall, in the sellar type sinus, and thickness of the bony sellar floor, in the sellar type sinus. Results: About 2% showed non-pneumatization of the sphenoid sinus. The pneumatization pattern was classified into conchal, pre sellar, and sellar types. The sphenoid sinus showed variable septation pattern. The commonest insertion of the septum was on the sellar floor (38.8%), while other insertion patters into the optic canal or carotid canal were also noted. The maximal intercarotid distance was 27 mm. Conclusion: The sphenoid sinus has lots of intrinsic variations in pneumatization pattern. Knowledge of detailed anatomy is crucial to minimize and prevent the intraoperative and postoperative complications. Hence, CT plays an inevitable role in the preoperative workup.
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