Is complex sphenoidal sinus anatomy a contraindication to a transsphenoidal approach for resection of sellar lesions? Presentation of a case series and review of the literature.

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Is complex sphenoidal sinus anatomy a contraindication to a transsphenoidal approach for resection of sellar lesions? Presentation of a case series and review of the literature.

World Neurosurg. 2017 Jan 05;:

Authors: Locatelli M, Di Cristofori A, Draghi R, Bertani G, Guastella C, Pignataro L, Mantovani G, Rampini P, Carrabba G

Abstract
BACKGROUND: The transsphenoidal approach (TNS) is considered the gold standard for resection of pituitary adenomas and other sellar region lesions. This approach is guided by few fundamental anatomical landmarks that conduct the surgeon toward the sellar floor. Some anatomical structures may vary a lot (e.g. intrasphenoidal septa, intercarotid distance) and may be difficult to identify. Among those structures, the pneumatization and conformation of the sphenoidal sinus (SS) plays a key role for accessing the floor of the sella and other skull base structures. In fact, a poorly pneumatized SS may be a relative contraindication to the TNS approach; in this study we analyzed outcome and complications in TNS for sellar lesions with difficult SS.
MATERIALS AND METHODS: A consecutive series of 243 patients submitted to TNS approach for sellar lesion was analyzed. Patients with a poor pneumatization of the SS were included. Neurosurgical and endocrinological outcomes were reported.
RESULTS: 15 patients with a low degree of pneumatization of the SS were successfully treated using a TNS approach matched with neuronavigation and Doppler US. Thirteen out of 15 patients had a pituitary adenoma. Endocrinological and neurosurgical outcome were similar to patients with normal pneumatization of the SS showing a cured disease in 6 out of 9 patients with functioning adenomas and an improvement of symptoms in case of non functioning adenomas.
CONCLUSIONS: Patients with a poorly pneumatized SS can be treated safely with a TNS approach using image guidance techniques in order to avoid major neurovascular complications.

PMID: 28065874 [PubMed - as supplied by publisher]

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