Gopalakrishnan Aparna, Ganesan Sivaraman, Ramesh Andi Sadayandi, Ramesh Ananthakrishnan, Penubarathi Lokesh Kumar, Raja Kalaiarasi, Lakshmanan Jijitha, Khushwaha Akshat, Kaushal Koshika, Alexander Arun
Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Tamil Nadu, India.
Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Tamil Nadu, India.
Int Arch Otorhinolaryngol. 2024 Oct 25;28(4):e643-e649. doi: 10.1055/s-0044-1788313. eCollection 2024 Oct.
Endoscopic transsphenoidal surgery (ETS) is the standard practice in pituitary surgeries. The sellar exposure becomes the main factor which determines the residual disease in ETS. Not many studies can be found in the literature on the influence of anatomical variations of the sphenoid on intraoperative sella exposure. The aim of the current study is to ascertain whether sphenoid sinus variations play a role in sellar exposure and residual tumor volume. This is a prospective study conducted in a south Indian tertiary care center between June 2020 to June 2022, with 21 study participants who were scheduled to have ETS. The relation of preoperative computed tomography (CT) and magnetic resonance imaging (MRI) parameters with the intraoperative area of sellar exposure and residual tumor volume was evaluated. Sphenoid sinus dimensions, like presellar width (mean = 1.89 ± 0.51 cm), maximum width (mean = 2.94 ± 1.09 cm), presellar depth (mean = 1.14 ± 0.55 cm), suprasellar depth (mean = 1.08 ± 0.24 cm), infrasellar depth (mean = 2.36 ± 0.92 cm), presellar height (mean = 2.22 ± 0.47 cm), or the 9 internal carotid artery (ICA)-related measures, did not have any correlation with the mean intraoperative area of sellar exposure (0.57 ± 0.28 cm ). Also, the adequacy of sellar exposure did not relate to the residual tumor. Preoperative tumor volume was found to be higher (20.2 [55.3-13.2] cm ) in patients with residual tumor compared with those with no residual tumor (5.9 [6.8-5.2] cm ). Tumor extension had a significant association with the residual tumor volume. According to the present study, anatomical variations of the sphenoid sinus do not influence the adequacy of sellar exposure. Further studies need to be undertaken concerning residual tumor volume as well as preoperative tumor volume and extension.
内镜经蝶窦手术（ETS）是垂体手术的标准术式。鞍区暴露成为决定ETS中残留疾病的主要因素。关于蝶骨解剖变异对术中鞍区暴露的影响，在文献中很难找到相关研究。
本研究的目的是确定蝶窦变异是否在鞍区暴露和残余肿瘤体积中起作用。
这是一项前瞻性研究，于2020年6月至2022年6月在印度南部的一家三级医疗中心进行，共有21名计划接受ETS的研究参与者。评估了术前计算机断层扫描（CT）和磁共振成像（MRI）参数与术中鞍区暴露面积和残余肿瘤体积的关系。
蝶窦尺寸，如鞍前宽度（平均=1.89±0.51厘米）、最大宽度（平均=2.94±1.09厘米）、鞍前深度（平均=1.14±0.55厘米）、鞍上深度（平均=1.08±0.24厘米）、鞍下深度（平均=2.36±0.92厘米）、鞍前高度（平均=2.22±0.47厘米），或9项与颈内动脉（ICA）相关的测量值，与术中鞍区暴露的平均面积（0.57±0.28平方厘米）均无相关性。此外，鞍区暴露的充分程度与残余肿瘤无关。发现有残余肿瘤的患者术前肿瘤体积（20.2[55.3 - 13.2]立方厘米）高于无残余肿瘤的患者（5.9[6.8 - 5.2]立方厘米）。肿瘤扩展与残余肿瘤体积有显著关联。
根据本研究，蝶窦的解剖变异不影响鞍区暴露的充分程度。需要进一步开展关于残余肿瘤体积以及术前肿瘤体积和扩展的研究。
