J Korean Neurosurg Soc.  2013 Apr;53(4):218-222. 10.3340/jkns.2013.53.4.218.

New Landmark for the Endoscopic Endonasal Transsphenoidal Approach of Pituitary Surgery

• Kim YH
• Kim JE
• Kim MJ
• Cho JH

• KMID: 1426207
• DOI: http://doi.org/10.3340/jkns.2013.53.4.218

Abstract

OBJECTIVE
To clarify the anatomical correlations of the sphenoid sinus with surrounding structures in the normal Korean population, and to identify surgical landmarks for safe sellar floor dissection in the anterior skull base by endoscopy and microscopy.
METHODS
We reviewed the 196 brain magnetic resonance imaging findings showing a normal appearance, and measured the distances between anatomical landmarks.
RESULTS
The mean distances from the base of the columella to the anterior wall of the sphenoid sinus and the sellar floor were 69.71+/-4.25 mm and 86.26+/-4.57 mm, respectively in the over 15 age group, and showed the smallest degree of variation among the measurements. The mean angles between the floor of the nasal cavity and the straight line connecting the base of the columella and the sellar floor were 29.45+/-3.25degrees and 24.75+/-4.00degrees in the over 15 and under 15 age groups, respectively. The mean values of both distances and angles increased with age until 15 years after which no further increases were evident. There were no significant differences in the measurements between males and females or among subjects with different degrees of pneumatization in the over 15 age group.
CONCLUSION
The distances from the base of the columella to the sellar floor and the anterior wall of the sphenoid sinus, which were consistent among individuals, could be used as a surgical indicator to investigate the sellar floor in endoscopic or microscopic transsphenoidal approaches.

Keyword

Pituitary gland; Neuroendoscopy; Sphenoid sinus; Skull base neoplasm

MeSH Terms

Brain
Endoscopy
Female
Floors and Floorcoverings
Humans
Magnetic Resonance Imaging
Male
Nasal Cavity
Neuroendoscopy
Pituitary Gland
Skull Base
Skull Base Neoplasms
Sphenoid Sinus

Figure

• 

  Fig. 1 Measurement of the distances between the base of the columella (BOC) and the anterior wall of the sphenoid sinus (AS) and between the BOC and the sellar floor (SF) on T1 weighted fast spin-echo sagittal images of the brain. We measured the line drawn between the BOC and the SF (double arrowed line) and determined the shortest distance between the BOC and the AS (dashed line) on that line. In addition, the angle (asterisk) between the nasal cavity floor and the line connecting the BOC and the SF was measured.

• 

  Fig. 2 Measurement of the anteroposterior distances between the anterior wall of the sphenoid sinus (AS) and the sellar floor (SF) and the craniocaudal distances between the planum sphenoidale (PS) and the SF on T1 weighted fast spin-echo sagittal images of the brain. We chose one point on the SF at which the perpendicular bony wall from the tuberculum sella turns horizontally, and measured the distance between the AS and the SF (horizontal line) and determined the shortest distance between the horizontal line and the PS (vertical line).

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  Fig. 3 The shortest distances between both internal carotid arteries and the anterior-most portions of the cavernous segment (C4) were measured on T2 weighted fast spin-echo axial images of the brain (double arrow).

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  Fig. 4 Mean values of the distance in patients grouped according to age at intervals of 3 years. A : Changes in distance between the base of the columella (BOC) and the sellar floor (SF) with age. B : Change in distance between the BOC and the anterior wall of the sphenoid sinus (AS) in relation to age. Mean values of the distance increased until age 15 and then showed a plateau.

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