Usefulness of oblique coronal CT and MRI imaging in the endoscopic endonasal approach to treat skull base lesions.

Usefulness of oblique coronal CT and MRI imaging in the endoscopic endonasal approach to treat skull base lesions.

World Neurosurg. 2018 Jan 08;:

Authors: Yano S, Shinojima N, Kitajima M, Uetani H, Hide T, Mukasa A

Abstract
OBJECTIVE: This report examines the utility of the preoperative image to orientate the surgeon in the sphenoid sinus during an endoscopic endonasal transsphenoidal approach (ETSS).
METHODS: ETSS was performed in 100 cases of sellar lesion and used to classify the sphenoid sinus septum shape. Preoperative CT and MRI scans were taken for two types of coronal imaging: conventional and oblique. Expected sphenoid sinus septum shape was compared with those from ETSS to estimate concordance. The confirmation rate of anatomical landmarks in the sphenoid sinus by endoscopic observation was compared in various types of septum and the identification rate in oblique coronal imaging was also examined.
RESULTS: The most common septum shape was single type (31%), followed by branched (26%), parallel (18%), none (12%), cross (9%), and bridge (4%) types. In oblique coronal images, preoperative evaluation and endoscopic findings were consistent in 93 to 100% of cases. However, with conventional coronal images, the concordance rate was 22.2 to 83.9%, and in the none, branched, and cross types, the concordance rate was significantly lower than that for oblique coronal images. Although confirmation of the midline through estimation of landmarks by endoscopic observation was difficult in 33 cases, preoperative CT and MRI showed landmarks in all cases and oblique coronal images best indicated the midline.
CONCLUSION: Use of oblique coronal images in addition to conventional images provided good orientation of anatomical structures in the sphenoid sinus. The combination of preoperative imaging and endoscopic observation could allow safer surgery in ETSS.

PMID: 29325947 [PubMed - as supplied by publisher]

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