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Surgical anatomic findings of sphenoid sinus in 1009 Iranian patients with pituitary adenoma undergoing endoscopic transsphenoidal surgery

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Abstract

Objective

The most common surgical technique for the management of pituitary adenomas is the endoscopic endonasal transsphenoidal approach (EEA). preoperative neuroimaging along with detecting surgical landmarks of the sphenoid sinus during surgery is important for making a successful operation.

Method

This study includes 1009 patients with pituitary adenomas who underwent EEA between 2013 and 2020. We evaluated the anatomical features of the sphenoid sinus through a panel of items obtained from imaging and intra-operative findings.

Results

Our result includes 57.38% nonfunctional, 8.42% cushing, 12.39% prolactinoma, and 21.8% acromegaly patients who had undergone endoscopic endonasal transsphenoidal surgery. The mean age of the patients was 45 with a male to female ratio of 1.2:1. Sellar sphenoid type was the most common (91.8%) with only 12% symmetrical inter sphenoid septa, Internal carotid artery dehiscence was found in 1.7% of the cases. Apoplexy was present in 6.3% of patients, which was found more prevalent in nonfunctional adenomas (9.67%, Odds ratio: 4.85, 95% CI 2.24–11.79) and further investigation revealed a significant association between apoplexy and sphenoid mucosal edema and hemorrhage (Odds ratio: 43.0, 95% CI 22.50–84.26), and between apoplexy and cystic lesions (OR = 4.14, 95% CI 1.87–8.45, P-value < 0.0001). Acromegaly is associated with the increased number of lateral recces (Odds ratio: 11.41, 95% CI 7.54–17.52), septation of the sphenoid sinus (Marginal mean: 3.92, 95% CI 3.69–4.14), edematous sinonasal mucosa (Odds ratio: 6.7; 95% CI 4.46–10.08), and higher bony (OR: 4.81, 95% CI 2.60–8.97, P-value < 0.001) and cavernous (OR: 1.7, 95% CI 1.13–2.46, P-value < 0.01) invasion.

Conclusion

The present study provides anatomical data about the sphenoid sinus and its adjacent vital structures with adenomal specific changes that are necessary to prevent complications during endoscopic advanced transsphenoidal surgery.

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Data Availability

Data available on request due to privacy/ethical restrictions.

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Authors and Affiliations

  1. Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Guive Sharifi, Mohammad Amin Dabbagh Ohadi & Arefe Bahranian

  2. Department of Otolaryngology, Head and Neck Surgery, Loghman Hakim Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Mohammad Abedi & Mahdi Khajavi

  3. Hearing Disorders Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Alireza Moradi

  4. Department of Otolaryngology, Head and Neck Surgery, Skull Base Research Center, Loghman Hakim Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Nader Akbari Dilmaghani

  5. Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran

    Mohammad Amin Dabbagh Ohadi

  6. Interdisciplinary Neuroscience Research Program, Tehran University of Medical Sciences, Tehran, Iran

    Mohammad Amin Dabbagh Ohadi

  7. Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA, USA

    Shima Shahjouei

Authors
  1. Guive Sharifi
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Correspondence to Nader Akbari Dilmaghani.

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Informed consent was obtained from all individual participants included in the study.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Shahid Beheshti University of medical sciences (ethical code: IR.SBMU.MSP.REC.1398.453).

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Sharifi, G., Ohadi, M.A.D., Abedi, M. et al. Surgical anatomic findings of sphenoid sinus in 1009 Iranian patients with pituitary adenoma undergoing endoscopic transsphenoidal surgery. Eur Arch Otorhinolaryngol 280, 2985–2991 (2023). https://doi.org/10.1007/s00405-022-07818-5

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