Rothman S L, Kier E L, Kirchner J A, Allen W E
Laryngoscope. 1975 Dec;85(12 pt 1):1986-98. doi: 10.1288/00005537-197512000-00004.
In recent years the transethmoidal and transnasal approaches to the pituitary gland have become increasingly popular. In each case, detailed preoperative analysis of the anatomy of the sphenoid sinus and its boundaries is crucial in facilitating entry to the pituitary fossa and in reducing intraoperative complications. Certain operative difficulties and complications are the result of the marked variability in the anatomy of the sphenoid bone and its sinus. These include: loss of orientation within a capacious sinus; perforation of the carotid artery or cavernous sinus; injury to the optic nerve or ophthalmic artery; and violation of the subarachnoid space with resultant pneumocephalus or cerebrospinal fluid rhinorrhea. Pneumatization develops originally within the presphenoid, beginning anteriorly and proceeding posteriorly. Around the time of puberty the pneumatization usually penetrates up to the spheno-occipital synchondrosis. Dense bony septa remain within the sinus along the plane of fusion of the various sphenoidal segments. Preoperative laminagraphy of these ridges and septa is extremely helpful in planning the safest and most direct route to the sella. Laminagraphy is preferable to routine skull films because the septal detail is unobscured by overlying facial structures. Pleuridirectional laminagraphic motion (circular or hypocycloidal) is preferred to linear motion because of the clarity and detail that they provide.
近年来，经筛窦和经鼻入路垂体手术越来越受欢迎。在每种情况下，术前对蝶窦及其边界的解剖结构进行详细分析对于进入垂体窝并减少术中并发症至关重要。某些手术困难和并发症是蝶骨及其窦的解剖结构显著变异的结果。这些包括：在宽大的窦内迷失方向；颈动脉或海绵窦穿孔；视神经或眼动脉损伤；以及侵犯蛛网膜下腔导致气颅或脑脊液鼻漏。气化最初在蝶骨前部开始，并向后发展。在青春期前后，气化通常会延伸至蝶枕软骨结合处。沿各蝶骨节段融合平面，窦内仍保留致密的骨间隔。术前对这些嵴和间隔进行体层摄影，对规划通往蝶鞍最安全、最直接的路径非常有帮助。体层摄影优于常规颅骨平片，因为间隔细节不会被面部结构遮挡。由于其提供的清晰度和细节，多向体层摄影运动（圆形或次摆线）优于直线运动。
