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Demonstration of the inferior intercavernous sinus is closely linked to the extent of pneumatization of the sphenoid sinus: useful information for the pituitary surgeon

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Abstract

Purpose

To study the utility of T2-weighted MRI sequences in the identification of the inferior intercavernous sinus (IICS), a potential source of bleeding during transsphenoidal surgery of pituitary adenomas.

Methods

Pituitary sagittal T1W and coronal T2W MRI sequences were analyzed in 237 consecutive patients, after the exclusion of postoperative MRIs and those revealing an empty sella or a pituitary macroadenoma. Sphenoid sinus pneumatization was defined as incomplete (group 1) if it did not reach the nadir of the sella turcica, as complete (group 2) if it extended beyond the nadir of the sella or asymmetric (group 3), when only one side of the sinus was completely pneumatized.

Results

In Group 2 (70% of the patients), the IICS was rarely visualized on coronal T2W MRI (6/167 patients—3.6%), whereas in Group 1 it was identified in nearly all patients (55/57 patients – 96.5%, p < 0.001). In Group 3, the IICS was only visible above the non-pneumatized part of the sphenoid sinus.

Conclusions

The IICS can be identified on coronal T2W images in patients with an incompletely pneumatized sphenoid sinus, but very rarely in patients with a totally pneumatized sinus. This information can help to increase awareness among pituitary surgeons of the need to potentially manage IICS bleeding during transsphenoidal surgery in patients with an incompletely pneumatized sphenoid sinus.

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Acknowledgements

The authors would like to thank Emmanuel Laurent for designing the illustrations and Adrian Daly for language revision of the text.

Funding

This study was supported in part by the Fonds d’Investissment pour la Recherche (FIRS) of the Centre Hospitalier Universitaire de Liege.

Author information

Authors and Affiliations

  1. Department of Medical Imaging, Centre Hospitalier de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000, Liège, Belgium

    Jean-François Bonneville & Luaba Tshibanda

  2. Department of Endocrinology. Centre Hospitalier de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000, Liège, Belgium

    Iulia Potorac, Patrick Petrossians & Albert Beckers

  3. Department of Neurosurgery, Centre Hospitalier de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000, Liège, Belgium

    Didier Martin

Authors
  1. Jean-François Bonneville
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  2. Iulia Potorac
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  3. Luaba Tshibanda
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  4. Didier Martin
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  5. Patrick Petrossians
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Contributions

JFB designed the study. JFB, LT, PP, IP and DM analysed the results of the research. JFB and IP prepared the manuscript. All authors reviewed the manuscript.

Corresponding author

Correspondence to Jean-François Bonneville.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

All imaging was performed during routine neurororadiological work-up of patients based on clinical indications; no prospective imaging of normal volunteers was performed in this study. As such, according to guidelines of the revised Declaration of Helsinki, this study reported the subsequent analysis of anonymous data (images) obtained from ‘routine sources’ where consent of individual patients and ethical approval for research analysis was, therefore, not considered necessary.

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This article does not contain any studies with human subjects or animals performed by the authors.

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Bonneville, JF., Potorac, I., Tshibanda, L. et al. Demonstration of the inferior intercavernous sinus is closely linked to the extent of pneumatization of the sphenoid sinus: useful information for the pituitary surgeon. Pituitary 25, 861–867 (2022). https://doi.org/10.1007/s11102-022-01267-3

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