Yano Shigetoshi, Shinojima Naoki, Kitajima Mika, Uetani Hiroyuki, Hide Takuichiro, Mukasa Akitake
Department of Neurosurgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
Department of Neurosurgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
World Neurosurg. 2018 May;113:e10-e19. doi: 10.1016/j.wneu.2018.01.022. Epub 2018 Jan 8.
This report examines the usefulness of the preoperative image to orient the surgeon in the sphenoid sinus during endoscopic endonasal transsphenoidal surgery (ETSS).
ETSS was performed in 100 cases of sellar lesion and used to classify the sphenoid sinus septum shape. Preoperative computed tomography and magnetic resonance imaging were performed for 2 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 anatomic 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.
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%-100% of cases. However, with conventional coronal images, the concordance rate was 22.2%-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 computed tomography and magnetic resonance imaging showed landmarks in all cases and oblique coronal images best indicated the midline.
Use of oblique coronal images in addition to conventional images provided good orientation of anatomic structures in the sphenoid sinus. The combination of preoperative imaging and endoscopic observation could allow safer surgery in ETSS.
本报告探讨术前影像在内镜下经鼻蝶窦手术（ETSS）中帮助外科医生定位蝶窦的实用性。
对100例鞍区病变患者进行ETSS，并对蝶窦隔形状进行分类。术前进行计算机断层扫描和磁共振成像，获取两种类型的冠状位影像：传统冠状位和斜冠状位。将预期的蝶窦隔形状与ETSS中的实际形状进行比较，以评估一致性。比较不同类型隔的蝶窦解剖标志在内镜观察下的确认率，并检查斜冠状位成像中的识别率。
最常见的隔形状为单类型（31%），其次为分支型（26%）、平行型（18%）、无隔型（12%）、交叉型（9%）和桥型（4%）。在斜冠状位影像中，93%-100%的病例术前评估与内镜检查结果一致。然而，在传统冠状位影像中，一致性率为22.2%-83.9%，在无隔型、分支型和交叉型中，一致性率显著低于斜冠状位影像。尽管通过内镜观察估计标志来确认中线在33例中存在困难，但术前计算机断层扫描和磁共振成像在所有病例中均显示了标志，且斜冠状位影像最能清晰显示中线。
除传统影像外，使用斜冠状位影像可更好地定位蝶窦的解剖结构。术前影像与内镜观察相结合可使ETSS手术更安全。
