Morphological and Metrical Relationships Between Sphenoid Sinus and Sella Turcica: Possible Applications in Transnasal Transsphenoidal Surgery

Abstract

Introduction: Transsphenoidal surgeries imply the risk of intraoperative lesions to the neurovascular structures surrounding the sphenoid sinus (SS). Aim of the present study is to assess the metrical and morphologic relationships existing between SS and sella turcica (ST). Materials and Methods: Two hundred computed tomography-scans of patients were selected. For each patient volumes of SS were calculated from their 3-dimensional models segmented through ITK-SNAP program. Variants of SS in pneumatisation and sellar diameters [antero-posterior (AP) diameter, depth, and length] were evaluated on each computed tomography-scan. Correlations among different measurements were assessed through Spearman test (P<0.01), whereas associations between sellar parameters and presence of pneumatisation variants were assessed through Mann-Whitney test (P<0.01). Results: In males, pneumatization of the greater wings was related to smaller AP diameter (P<0.01) and depth of ST (P<0.01), whereas in females lower values of depth were found in patients with pneumatization of the pterygoid processes (P<0.01). In both sexes, a positive correlation was found between AP diameter and, respectively, length and depth of ST (P<0.01), together with a negative correlation between volume of SS and depth of ST (P<0.01). Lastly, in females a positive correlation was found between age and, respectively, length and depth of ST (P<0.01). Conclusions: The present study highlighted new metrical and morphologic relationships between volume and pneumatisation of SS and diameters of ST. Knowledge of these correlations allows to understand more clearly, in the preoperative setting, the surgical working space. Further studies are needed, especially for what concerns the relationship between sellar measurements and age in females.