Anatomical Variations of the Sphenoid Sinus in Acromegalic versus Non-Acromegalic Patients with Pituitary Adenoma: Implications for Surgical Planning
Abstract
Objective: To compare the anatomical differences of the sphenoid sinus and adjacent critical structures between patients with hormone-producing pituitary tumors, distinguishing between acromegalic and non-acromegalic groups, to optimize surgical planning and anticipate potential complications.
Material and Methods: A retrospective analysis was conducted on 150 patients diagnosed with hormone-secreting pituitary adenomas (50 acromegalic and 100 non-acromegalic) treated at the Neurosurgery Outpatient Clinic, Songklanagarind Hospital, between January 1, 2012 and December 31, 2022. Patient demographics and sphenoid sinus anatomical characteristics were assessed using computed tomography (CT) scans in collaboration with radiologists. Statistical analysis was performed using the R program with a significance threshold of p-value<0.05.
Results: Acromegalic patients exhibited significantly higher rates of post-sellar sphenoid pneumatization (p-value=0.002), sphenoid septum attachment to the optic nerve (p-value=0.018), and Onodi cells (p-value=0.011). The distance between the sphenoid rostrum and Vidian canal was significantly greater in acromegalic patients (p-value<0.001 right side, p-value=0.008 left side). Additionally, acromegalic patients had higher incidences of Vidian nerve protrusion (p-value=0.013), optic nerve protrusion (p-value<0.001), optic nerve dehiscence (p-value=0.025), and internal carotid artery (ICA) dehiscence (p-value=0.034). The intercarotid distance was significantly narrower in acromegalic patients (mean 16.4 mm, p-value<0.001).
Conclusion: Patients with acromegaly and hormone-secreting pituitary adenomas demonstrate distinct anatomical variations in the sphenoid sinus and adjacent structures compared to non-acromegalic patients. These differences underscore the necessity for thorough preoperative evaluation and meticulous surgical planning to minimize risks during transsphenoidal pituitary surgery.
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