Background: Sphenoid sinus (SS) is separated by a septum with various position, therefore sizes of two sinus cavities are variable [2]. In addition, sphenoid sinus differs in pneumatization type, ranging from its absence to extensive forms.Knowledge of the linear size and shape of the skull, the structure of the sphenoid sinus and its interconnection with nearby structures will help to avoid complications when performing surgical endoscopic interventions in the chiasmal-sellar region. Currently, the transsphenoid approach is the most optimal in neurosurgery for intracellar and cranial pathologies treatment. Due to proximity and anatomical interconnection of sphenoid sinus with other anatomical structures, such as anterior knees of intracavernous segments of internal carotid artery (ICA), optic nerve (ON), there is a high risk of complications during surgery [1,2,3,4].
Purpose: Features of skull craniometric parameters, the type sphenoid sinus pneumatization, and its practical value in various ON and ICA positions.
Methods: The retrospective research, using magnetic resonance imaging (MRI) scans of head, included 1111 people, with 410 males and 701 females out of them but the scope of the article is limited to 93 of them, including 34 males (37%) and 59 females (63%) aged from 20 to 71 years. The research design complies with the Helsinki Declaration’s provisions and was approved by the Local Ethics Committee of the West Kazakhstan Medical University named after Marat Ospanov №50 from January 17, 2020. The average age of males was 41.6 (20 – 71 years), and for females was 41.7 (20 – 66 years). Inclusion criteria were as the following: 1) age range from 20 to 71 years, 2) patients living in Aktobe region, 3) patients sent for examination with pituitary (hypophysis) pathology, 5) patients referred with CSR vascular pathology, 6) patients referred for verification of CSR pathology diagnosis. Exclusion criteria were as the following: 1) patients with skull bones fractures, 2) patients after skull trepanation, 3) patients having orthodontic and orthognathic research at examination time, 4) patients with congenital skull malformations, having gross skull deformation, 5) patients with brain tumors and hemorrhages with obvious CSR compression at examination time, 6) pregnancy, lactation, long-term use of hormonal drugs by persons of both gender. With the RadiAnt Dicom Viewer 5.5.1 program measured craniological indices: crosslongitudinal skull index, degree of pneumatization of the sphenoidal sinus; protrusion and/or gaping of internal carotid artery canal and optic nerve.Allstatistical analyses were performed using Statistica 8.0.
Results: The data we obtained show that the vast majority of older males (60-80 years old) had mesocrane skull shape, in contrast to females, among whom the frequency of brachycrane skull shape prevails. Among 20-40 years aged males, the highest percentage falls on mesocrane skull form, while in females the frequencies of mesocrane and brachycrane skull forms are relatively the same. In males and females with ages of 40-60 years, mesocrane and brachycranean skull forms are almost half of the total number of cases. An interesting fact was that dolichocranous skull shape is absolutely not found in both males and females of 40-80 years old age. The skull structure distribution by gender. Based on the sphenoid sinus types classification by Ossama & Guldner, our research revealed that there is no Conchal type (type I) in both genders. In 20-40 age, type III prevailed among males, while type IV has a maximum among females. Types III and IV predominated among males and females of 40-60 years old age. In 60-80 years category, type III prevails among females, while males have two times less. Type II is absent among 40-60 aged males and 60-80 aged females. As per the research of anatomical structures close to SS, it was found that ON and ICA canals form protrusions on the inner surface of the sphenoid sinus sidewall. The protrusion degree was ranged from a slight depression on the lateral wall to a complete "immersion" of canals into the sinus. No protrusion of ON and ICA canals were found in 60-80 years old males in 80% of cases, while complete absence of protrusion was shown in case of the same age females. However, protrusion of only the ICA canal occurs in 60% of cases with over 60 years old age females, while the same was in only 20% with the same age males. There was no case of ON canal protrusion in males, but ON canal gave a protrusion in sphenoid sinus wall in 49% of 20-40 years old females. ON and ICA canals protrusion in 20-60 years old males was found in about 30%, and the same protrusion was found in 60-80 years old females in 40%.
Conclusions: This study is aimed at identifying the features of structure of the sphenoidal sinus, focusing on the absence of a dolichocrane type of skull among the population, on the clear distinction between men and women by the type of skull structure and the features of pneumatization of the sphenoidal sinus. The presellar type of sphenoidal sinus has a virtually low adherence to changes in sinus canals in types II and IV. Thus, careful planning of trans-sphenoid access to the sella is possible with modern imaging methods. Different anatomical variations can be detected so that problems can be predicted to be assessable. In order to avoid morbid consequences during surgery, it is imperative that clinicians determine the location and extent of sphenoid sinus walls and its relation to adjacent vital structures whenever trans-sphenoid pituitary surgery is expected. The few surgical tips related to sphenoid sinus anatomical configuration are important to keep in mind during such an approach.
Keywords: MRI; sphenoid sinus; pneumatization; internal carotid artery; optic nerve
NEUROIMAGING DATA OF THE STUDY OF THE CHIASMAL-SELLAR REGION STRUCTURES