Department of Neurosurgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan,
Pituitary. 2013 Dec;16(4):465-70. doi: 10.1007/s11102-013-0492-2.
The intercarotid distance (ICD) between cavernous carotid arteries (CCAs) is an important factor for avoiding injury of the internal carotid artery during transsphenoidal surgery. The ICD between CCAs in pituitary adenoma patients is generally larger than in normal individuals. However, the movement of the CCA during transsphenoidal surgery is not known. The aim of this study is to measure the ICD between CCAs in pituitary adenoma patients before and after surgery. We reviewed 138 pituitary adenoma patients who were treated with resection via the transsphenoidal approach. The CCA diameter and the ICD between CCAs were measured from preoperative and postoperative MR images. The CCA diameter was similar at the preoperative and postoperative time points. On the other hand, the ICD between CCAs was shorter at postoperative time point (19.4 ± 4.5 mm) than at the preoperative time point (20.9 ± 4.9 mm) (P = 0.048). Above all, invasion type adenomas had more significant ICD change at the postoperative time point (23.8 ± 3.8 mm) than at the preoperative time point (21.6 ± 3.9 mm) (P = 0.008). Also in multivariate analysis, cavernous sinus invasion of adenoma was independently associated with ICD contraction >2 mm (P = 0.027). It is important to know the change in ICD between CCAs after transsphenoidal surgery, particularly for pituitary adenomas with cavernous sinus invasion. The position of the CCA should be known before and during transsphenoidal surgery, as well before and during the second operation to avoid vascular injuries.
颈内动脉海绵窦段（CCAs）之间的距离（ICD）是避免经蝶窦手术中颈内动脉损伤的一个重要因素。垂体瘤患者的颈内动脉海绵窦段之间的 ICD 一般比正常人更大。然而，CCAs 在经蝶窦手术中的运动情况尚不清楚。本研究旨在测量垂体瘤患者手术前后颈内动脉海绵窦段之间的 ICD。我们回顾了 138 例经蝶窦入路手术切除的垂体瘤患者。从术前和术后的 MRI 图像上测量了颈内动脉直径和颈内动脉海绵窦段之间的 ICD。术前和术后颈内动脉直径相似。另一方面，颈内动脉海绵窦段之间的 ICD 在术后时间点（19.4 ± 4.5 mm）比术前时间点（20.9 ± 4.9 mm）更短（P = 0.048）。总之，侵袭性腺瘤在术后时间点（23.8 ± 3.8 mm）比术前时间点（21.6 ± 3.9 mm）的 ICD 变化更为显著（P = 0.008）。多变量分析还表明，腺瘤的海绵窦侵犯与 ICD 收缩>2 mm 独立相关（P = 0.027）。了解经蝶窦手术后颈内动脉海绵窦段之间 ICD 的变化非常重要，特别是对于有海绵窦侵犯的垂体瘤。在经蝶窦手术前、手术中和第二次手术前、手术中都应该了解颈内动脉的位置，以避免血管损伤。
