Surgical Anatomy of the Sphenoid Sinus, Sella Turcica, and Parasellar Regions

Lateral sphenoid encephaloceles of the Sternberg canal are rare entities and usually present with spontaneous CSF rhinorrhea. Traditionally, these were treated via transcranial approaches, which can be challenging given the deep location of these lesions. However, with advancements in endoscopic skull base surgery, including improved surgical exposures, angled endoscopes and instruments, and novel repair techniques, these encephaloceles can be resected and successfully repaired with purely endoscopic endonasal approaches. In this report, the authors review the endoscopic endonasal transpterygoid approach to the lateral recess of the sphenoid sinus for repair of temporal lobe encephaloceles, including an overview of the surgical anatomy from an endoscopic perspective, and describe the technical operative nuances and surgical pearls for these cases. The authors also present 4 new cases of lateral sphenoid recess encephaloceles that were successfully treated using this approach.

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Sphenoid sinus barotrauma with intracranial air in sella turcica after diving

Acta Radiologica ◽

10.1080/02841850600771494 ◽

2006 ◽

Vol 47 (8) ◽

pp. 872-874 ◽

Cited By ~ 10

Author(s):

G. Tryggvason ◽

B. Briem ◽

Ó. Guðmundsson ◽

H. Einarsdóttir

Keyword(s):

Sphenoid Sinus ◽

Sella Turcica ◽

Sinus Barotrauma

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Endoscopic anatomy of the sphenoid sinus

The Journal of Laryngology & Otology ◽

10.1017/s0022215100143361 ◽

1999 ◽

Vol 113 (2) ◽

pp. 122-126 ◽

Cited By ~ 30

Author(s):

Samy Elwany ◽

Ibraheim Elsaeid ◽

Hossam Thabet

Keyword(s):

Optic Nerve ◽

Carotid Artery ◽

Sphenoid Sinus ◽

Sella Turcica ◽

Clinical Importance ◽

Sinus Surgery ◽

Endoscopic Anatomy ◽

Relationship Of ◽

The Relationship ◽

Sphenoid Sinuses

AbstractThe anatomy of the sphenoid sinus, as it relates to endoscopic sinus surgery, was studied in 93 cadaver heads (186 sphenoid sinuses) using endoscopic dissections as well as sagittal sections. The relationship of the sphenoid sinuses to the carotid artery, optic nerve, floor of sella turcica, as well as other important structures, were verified and discussed. The recesses of the sinus as well as its ostium and accessory septa and crests were described and their clinical importance was discussed. Pertinent measurements were included wherever appropriate.

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Pituitary macroadenoma presenting as a nasal tumor: case report

Sao Paulo Medical Journal ◽

10.1590/1516-3180-2014-1326693 ◽

2014 ◽

Vol 132 (6) ◽

pp. 377-381 ◽

Cited By ~ 2

Author(s):

Nivaldo Adolfo Silva Junior ◽

Fabiano Reis ◽

Larissa Kaori Miura ◽

Guilherme Henrique Vieira ◽

Luciano Souza Queiroz ◽

...

Keyword(s):

Pituitary Adenoma ◽

Nasal Cavity ◽

Nasal Obstruction ◽

Sphenoid Sinus ◽

Sella Turcica ◽

Rare Condition ◽

Lower Surface ◽

Large Mass ◽

Histopathological Analysis ◽

Tumor Extension

CONTEXT: Pituitary macroadenomas are rare intracranial tumors. In a few cases, they may present aggressive behavior and invade the sphenoid sinus and nasal cavity, causing unusual symptoms. In this paper, we report an atypical case of pituitary adenoma presenting as a nasal mass.CASE REPORT: The patient was a 44-year-old woman who had had amenorrhea and galactorrhea for ten months, with associated nasal obstruction, macroglossia and acromegaly. Both growth hormone and prolactin levels were increased. Magnetic resonance imaging showed a large mass originating from the lower surface of the pituitary gland, associated with sella turcica erosion and tumor extension through the sphenoid sinus and nasal cavity. Histopathological analysis demonstrated a chromophobe pituitary adenoma with densely packed rounded epithelial cells, with some atypias and rare mitotic figures. There was no evidence of metastases.CONCLUSION: Macroadenoma invading the nasal cavity is a rare condition and few similar cases have been reported in the literature. This study contributes towards showing that tumor extension to the sphenoid sinus and nasopharynx needs to be considered and investigated in order to make an early diagnosis when atypical symptoms like nasal obstruction are present.

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Variations of sphenoid pneumatization: a CBCT study

Romanian Journal of Rhinology ◽

10.1515/rjr-2015-0013 ◽

2015 ◽

Vol 5 (18) ◽

pp. 107-113

Author(s):

Catalina Craiu ◽

Mihai Sandulescu ◽

Mugurel Constantin Rusu

Keyword(s):

Sphenoid Sinus ◽

Anatomic Variation ◽

Sella Turcica ◽

Middle Cranial Fossa ◽

Maxillary Nerve ◽

Onodi Cell ◽

Cranial Fossa ◽

Left And Right ◽

Air Cells ◽

Case Basis

AbstractBACKGROUND. The pneumatization pattern of the sphenoid sinus seems rather unpredictable, as resulted from previous studies. It is however extremely important for endoscopic approaches to target structures of the middle cranial fossa, such as the pituitary gland.MATERIAL AND METHODS. We aimed at documenting by Cone Beam Computed Tomography (CBCT) the possibilities of anatomic variation of the sphenoid sinus. 25 randomly selected patients were retrospectively analyzed.RESULTS. In 56%, the left and right sphenoidal sinuses were bilaterally symmetrical with respect to the sagittal pneumatization type: four patients had sellar types, one had presellar type and in nine cases the sphenoidal sinuses were reaching posteriorly to the sella turcica. Only in 8% of cases were found conchal types of pneumatization, but they were part of anatomical pictures including Onodi air cells. Such an Onodi cell presented a posterior (sphenoidal) recess reaching posteriorly and superiorly to the pterygopalatine fossa. The recesses of the sphenoid sinus were also documented: anterior or septal, ethmoidal, maxillary, clinoidal and lateral. In 32% was found a lateral recess only engaged between the vidian and maxillary nerve canals.CONCLUSION. It appears that CBCT is a reliable tool for accurate anatomic identification of the sphenoid sinus pneumatization pattern, on a case-by-case basis.

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Sphenoid Sinus Osteoma at the Sella Turcica Associated with Empty Sella: CT and MR Imaging Findings: Fig 1.

American Journal of Neuroradiology ◽

10.3174/ajnr.a0935 ◽

2008 ◽

Vol 29 (3) ◽

pp. 550-551 ◽

Cited By ~ 9

Author(s):

C.Y. Chen ◽

S.H. Ying ◽

M.S. Yao ◽

W.T. Chiu ◽

W.P. Chan

Keyword(s):

Mr Imaging ◽

Sphenoid Sinus ◽

Sella Turcica ◽

Empty Sella ◽

Imaging Findings

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A morphometric survey of the parasellar region in more than 2700 skulls: emphasis on the middle clinoid process variants and implications in endoscopic and microsurgical approaches

Journal of Neurosurgery ◽

10.3171/2017.2.jns162114 ◽

2018 ◽

Vol 129 (1) ◽

pp. 60-70 ◽

Cited By ~ 8

Author(s):

Akshay Sharma ◽

Gabrielle E. Rieth ◽

Joseph E. Tanenbaum ◽

James S. Williams ◽

Nakao Ota ◽

...

Keyword(s):

Sella Turcica ◽

Significant Risk ◽

Surgical Anatomy ◽

Ct Scans ◽

Anterior Clinoid Process ◽

White Race ◽

Explanatory Variables ◽

Optic Strut ◽

Parasellar Region ◽

Data Points

OBJECTIVEThe middle clinoid process (MCP) is a bony projection that extends from the sphenoid bone near the lateral margin of the sella turcica. The varied prevalence and morphological features of the MCP in populations stratified by age, race, and sex are unknown; however, the knowledge of its anatomy and preoperative recognition on CT scans can aid greatly in complication avoidance and management. The aim of this study was to further illustrate the surgical anatomy of the parasellar region and to quantify the incidence of MCP and caroticoclinoid rings (CCRs) in dried preserved human anatomical specimens.METHODSThe presence, dimensions, morphological classification (incomplete, contact, and CCR), and intracranial relations of the MCP were measured in 2726 dried skull specimens at the Hamann-Todd Osteological Collection at the Cleveland Museum of Natural History. Specific morphometric data points were recorded from each of these hemiskulls, and categorized based on age, sex, and ethnicity. Linear and logistic regressions were used to determine associations between explanatory variables and MCP morphology. Computed tomography scans of the skull specimens were obtained to explore radiological landmarks for different types of MCPs. Illustrative intraoperative videos were also analyzed in the light of these crucial surgical landmarks.RESULTSThe sample included 2250 specimens from males and 476 from females. Specimens were classified as either “white” (60.5%) or “black” (39.2%). An MCP was found in 42% of specimens, with 60% of those specimens presenting bilaterally. Fully ossified CCR comprised 27% of all MCPs, and contact (defined as contact without ossification between MCP and anterior clinoid process) comprised 4% of all MCPs. White race (relative to black race) and increasing age were significant predictors of MCP presence (p < 0.001). White race was significantly associated with greater average MCP height (p < 0.001). Among skulls with CCR, both male sex and older age (> 70 years relative to < 50 years) were associated with increased CCR diameter (p < 0.001). No other significant predictors or associations were observed. The CT scans of skulls replicated and validated the authors’ morphometric observations on incomplete, contact, and CCR patterns adequately. The surgical strategies of clinoid bone removal are validated, with appropriate video illustrations.CONCLUSIONSVariations in the patterns of bony MCPs can pose a significant risk for injury to the internal carotid artery during parasellar procedures, especially those involving clinoidectomy and optic strut drilling. Understanding parasellar anatomy, especially on skull-base CT imaging, may be integral to surgical planning and preoperative risk counseling in both transcranial and extended endonasal procedures, as well as to preparing for complications management perioperatively.

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Thickening of sphenoid sinus mucosa during the acute stage of pituitary apoplexy

Journal of Neurosurgery ◽

10.3171/jns.2001.95.5.0897 ◽

2001 ◽

Vol 95 (5) ◽

pp. 897-901 ◽

Cited By ~ 29

Author(s):

Kazunori Arita ◽

Kaoru Kurisu ◽

Atushi Tominaga ◽

Kazuhiko Sugiyama ◽

Fusao Ikawa ◽

...

Keyword(s):

Transsphenoidal Surgery ◽

Sphenoid Sinus ◽

Pituitary Apoplexy ◽

Sella Turcica ◽

Acute Stage ◽

Mr Images ◽

Content Type ◽

Subepithelial Layer ◽

Sinus Mucosa ◽

Fine Print

✓ The authors treated two patients with pituitary apoplexy in whom magnetic resonance (MR) images were obtained before and after the episode. Two days after the apoplectic episodes, MR imaging demonstrated marked thickening of the mucosa of the sphenoid sinus that was absent in the previous studies. The relevance of this change in the sphenoid sinus was investigated. Retrospective evaluations were performed using MR images obtained in 14 consecutive patients with classic pituitary apoplexy characterized by acute onset of severe headache. The mucosa of the sphenoid sinus had thickened predominantly in the compartment just beneath the sella turcica, in nine of 11 patients, as ascertained on MR images obtained within 7 days after the onset of apoplectic symptoms. This condition improved spontaneously in all four patients who did not undergo transsphenoidal surgery. The sphenoid sinus mucosa appeared to be normal on MR images obtained from three patients at the chronic stage (> 3 months after onset). The incidence of sphenoid sinus mucosal thickening during the acute stage was significantly higher in the patients with apoplexy than that in the 100 patients without apoplexy. A histological study conducted in four patients who underwent transsphenoidal surgery during the early stage showed that the subepithelial layer of the sphenoid sinus mucous membrane was obviously swollen. The sphenoid sinus mucosa thickens during the acute stage of pituitary apoplexy. This thickening neither indicates infectious sinusitis nor rules out the choice of the transsphenoidal route for surgery.

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Sublabial rhinoseptoplastic technique for transsphenoidal pituitary surgery by a hinged-septum method

Journal of Neurosurgery ◽

10.3171/jns.1980.52.6.0867 ◽

1980 ◽

Vol 52 (6) ◽

pp. 867-870 ◽

Cited By ~ 22

Author(s):

Takanori Fukushima ◽

Keiji Sano

Keyword(s):

Sphenoid Sinus ◽

Sella Turcica ◽

Pituitary Surgery ◽

Anterior Wall ◽

Surgical Instruments ◽

En Bloc ◽

Content Type ◽

Anterior Nasal Spine ◽

Transsphenoidal Pituitary Surgery ◽

Mucosal Perforation

✓ A new modification of the transseptal, transsphenoidal approach to the sella turcica is described. The procedure consists of unilateral dissection of the septal mucosa through a sublabial route, and retraction of the entire nasal septum with its upper attachment as a hinge. For mobilization of the septum, an L-shaped osteotomy is made along the base of the septum and along the anterior wall of the sphenoid sinus. It provides adequate exposure of the sphenoid sinus while preserving the septal structures. The anterior nasal spine and the edges of the nares are also left intact. The anterior wall of the sphenoid sinus is resected en bloc and is used as a bone splint for the reconstruction of the sellar floor. This approach has been performed in 45 cases of pituitary adenoma, one of craniopharyngioma, and one with sphenoid mucocele. There was no instance of complications such as mucosal perforation, septal deformity, or infection. Modifications of the surgical instruments used are described.

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