Neurosurgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milano, Via Francesco Sforza 35, 20122, Milano, MI, Italy.
Acta Neurochir (Wien). 2013 Jan;155(1):125-30; discussion 130. doi: 10.1007/s00701-012-1527-6. Epub 2012 Nov 25.
Transphenoidal surgery is an effective treatment for acromegalic patients with growth hormone (GH) producing pituitary adenomas. Since acromegaly is a systemic disease which causes multiple bony alterations, we hypothesized that it could affect the sphenoid sinus anatomy. The aim of the study was to determine whether acromegalic patients have sphenoid sinus alterations with potential surgical impact.
Fourty-six consecutive patients (23 acromegalics-GH group, 23 non-acromegalics-nGH group) undergoing transphenoidal surgery were included in this study. Pre-operative volumetric CT scan of the head was used to assess the following anatomic characteristics: type of sphenoid sinus (sellar, pre-sellar, conchal); number of intrasphenoid septa; number of carotid-directed septa; intercarotid distance; depth of the sphenoid sinus; depth and size of the sella.
The sphenoid sinus was of the pre-sellar/conchal type in 26 % of the patients with acromegaly (n = 23) versus 9 % of the patients of the nGH group (n = 23). The number of intrasphenoid septations was significantly higher in the GH group than in the nGH group (P = .03). Interestingly, the intercarotid distance was smaller in GH patients than in nGH displaying a trend toward significance (P = .05). The sphenoid bone was deeper in the GH group as compared to the nGH group (P = .01) but the distance sphenoid sinus-sella was reduced (P < .01). Finally, the sella was not deeper, nor larger in acromegalic patients.
The sphenoid sinus of acromegalic patients resulted in being deeper, characterized by more septa and by a reduced intercarotid distance. These alterations deserve special pre- and intraoperative care, being potentially responsible for surgical difficulties.
经蝶窦手术是治疗生长激素（GH）分泌型垂体腺瘤所致肢端肥大症患者的有效方法。由于肢端肥大症是一种全身性疾病，会引起多种骨骼改变，我们假设它可能会影响蝶窦的解剖结构。本研究旨在确定肢端肥大症患者的蝶窦是否存在潜在手术影响的改变。
本研究纳入了 46 例连续接受经蝶窦手术的患者（23 例肢端肥大症-生长激素组，23 例非肢端肥大症-非生长激素组）。术前头颅容积 CT 扫描用于评估以下解剖特征：蝶窦类型（鞍内型、鞍前型、海绵型）；蝶窦内间隔数量；颈动脉指向性间隔数量；颈内动脉间距；蝶窦深度；蝶鞍深度和大小。
肢端肥大症患者的蝶窦为鞍前/海绵型者占 26%（n=23），而非肢端肥大症患者的占 9%（n=23）。生长激素组的蝶窦内间隔数量明显多于非生长激素组（P=0.03）。有趣的是，生长激素组患者的颈内动脉间距较小，具有统计学意义（P=0.05）。与非肢端肥大症组相比，肢端肥大症组患者的蝶骨更深（P=0.01），但蝶鞍-蝶窦距离减小（P<0.01）。最后，肢端肥大症患者的蝶鞍不更深，也不更大。
肢端肥大症患者的蝶窦更深，间隔更多，颈内动脉间距更小。这些改变需要特别的术前和术中护理，可能是导致手术困难的原因。
