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Radiological features for the approach in trans-sphenoidal pituitary surgery

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Abstract

Introduction

In order to perform trans-sphenoidal endoscopic pituitary surgery safely and efficiently it is important to identify anatomical and pituitary disease features on the pre-operative CT and MRI scans; thereby minimising the risk to surrounding structures and optimising outcomes. We aim to create a checklist to streamline pre-operative planning.

Methods

We retrospectively reviewed pre-operative CT and MRI scans of 100 adults undergoing trans-sphenoidal endoscopic pituitary surgery.

Results

Radiological findings and their incidence included deviated nasal septum (62%), concha bullosa (32%), bony dehiscence of the carotid arteries (18%), sphenoid septation overlying the internal carotid artery (24% at the sella) and low lying CSF (32%). The mean distance of the sphenoid ostium to the skull base was 10 mm (range 2.7–17.6 mm). We also describe the ‘teddy bear’ sign which when present on an axial CT indicates the carotid arteries will be identifiable intra-operatively.

Conclusions

There are significant variations in the anatomical and pituitary disease features between patients. We describe a number of features on pre-operative scans and have devised a checklist including a new ‘teddy bear’ sign to aid the surgeon in the anatomical assessment of patients undergoing trans-sphenoidal pituitary surgery.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK

    Victoria Twigg, Simon D. Carr, Ramkishan Balakumar & Showkat Mirza

  2. Department of Neurosurgery, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK

    Saurabh Sinha

  3. Department of Neurosurgery, Sheffield Children’s Hospital, Western Bank, Sheffield, S10 2TH, UK

    Saurabh Sinha

Authors
  1. Victoria Twigg
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  2. Simon D. Carr
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  3. Ramkishan Balakumar
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  4. Saurabh Sinha
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  5. Showkat Mirza
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Corresponding author

Correspondence to Victoria Twigg.

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None declared.

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Not required as retrospective study of anonymous images.

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Twigg, V., Carr, S.D., Balakumar, R. et al. Radiological features for the approach in trans-sphenoidal pituitary surgery. Pituitary 20, 395–402 (2017). https://doi.org/10.1007/s11102-017-0787-9

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  • DOI: https://doi.org/10.1007/s11102-017-0787-9

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