Department of Neurosurgery, The Affiliated Hospital of Putian University, Putian, P.R. China; Department of Neurosurgery, 900th Hospital, Fujian Medical University, Fuzong College, Fuzhou, P.R. China.
Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, P.R. China.
World Neurosurg. 2020 Jul;139:e677-e685. doi: 10.1016/j.wneu.2020.04.110. Epub 2020 Apr 24.
In this study, the sellar floor morphology of patients with pituitary adenoma is analyzed and a simple yet reliable method is identified to determine the location of bone window opening.
Clinical information of 144 consecutively admitted patients was retrospectively analyzed. Enhanced magnetic resonance imaging of the midsagittal plane was selected as the reference for classifying the sellar floor. Intraoperative tumor location, extent of tumor resection, and follow-up results were analyzed for different types of sellar floor. The tuberculum sellae, lowest point of the sphenoid sinus, and the lowest point of the sellar floor and 3 lines related to them were used to classify the sellar floor. This is referred to as the "three points and three lines" method.
Based on its location in the sphenoid sinus, the sellar floor can be classified into 4 types: 12 patients (8.3%) with high sellar, 70 (48.6%) with medium sellar, 30 (20.8%) with low sellar, and 32 (22.8%) with steep sellar. The maximum tumor diameter, maximum sellar floor diameter, and the intercarotid distance were all significantly different among patients with different types of sellar floor (P < 0.001). For all patients, quick intraoperative location of the sellar floor opening was achieved. A total of 104 patients (72.2%) had total tumor resection, 28 (19.40%) had subtotal tumor resection, and 4 (2.8%) had partial tumor resection. Twenty patients (13.9%) experienced cerebrospinal fluid leak, and there was no significant difference in cerebrospinal fluid leak rate among groups.
Presurgical classification and location of the sellar floor are critical for understanding and assessing the transsphenoidal approach. Different types of sellar floor appeared in the surgery with different morphologic features. The three points and three lines method helps the surgeon to predetermine the location of the sellar floor opening and to shorten surgical time.
本研究旨在分析垂体瘤患者鞍底形态，并确定一种简单而可靠的方法来确定骨窗开口的位置。
回顾性分析 144 例连续入院患者的临床资料。选择正中矢状面增强磁共振成像作为鞍底分类的参考。分析不同类型鞍底的肿瘤位置、肿瘤切除程度和随访结果。使用鞍结节、蝶窦最低点和鞍底最低点及与之相关的 3 条线对鞍底进行分类，称为“三点三线”法。
根据其在蝶窦中的位置，鞍底可分为 4 型：高鞍底 12 例（8.3%），中鞍底 70 例（48.6%），低鞍底 30 例（20.8%），陡鞍底 32 例（22.8%）。不同鞍底类型患者的最大肿瘤直径、最大鞍底直径和颈内动脉间距均有显著差异（P<0.001）。对于所有患者，均能快速确定鞍底开口的位置。共有 104 例（72.2%）患者行全切除，28 例（19.4%）患者行次全切除，4 例（2.8%）患者行部分切除。20 例（13.9%）患者发生脑脊液漏，各组间脑脊液漏发生率无显著差异。
术前鞍底分类和定位对于理解和评估经蝶窦入路至关重要。不同类型的鞍底在手术中表现出不同的形态特征。“三点三线”法有助于术者预先确定鞍底开口的位置，缩短手术时间。
