An Anatomi And Imaging Study Of Transsphenoidal Approach To Sellar Region

Objectives:1.The computer multiplanar reconstruction, three-dimensional reconstruction imageand surgical approach simulation were made to construct a conceptual stereostructure ofsellar region for the benefit of the surgical approach and providing a safe, efficient,time-saving and convenient transsphenoidal approach for the removal of tumor in sellarregion.2.The cadaveric heads were dissected and the CT pictures of the patients withpituitary tumor were measured to set up the anatomic and imaging data on structures ontranssphenoidal approach to sellar region.3.Using the multiplanar reconstruction and three dimensional reconstruction imageguide clinical surgeries.Methods:After fixed with10%formalin the anatomical structure on approach of single-nostrilto sellar region from15adult cadaveric heads were dissected and measured and thetranssphenoidal approach for surgery was also been simulated.VR and MPR Imaging of60patients with pituitary tumor,which has not destroyed thesellar region, were taken to measure the morphological parameters of relevant structures ontransphenoidal approach to sellar region,and make the multiplanar reconstruction and threedimensional reconstruction aided by CT.1During dissection we observed and made measurements as following:1)the size andshape of nostrils, the columella nasi.2) the size, shape, thickness, mucosa and deviation ofnasal septum.3) the shape of middle nasal concha, especially whether there were anatomicvariances such as inverse bending and gasification of middle nasal concha.4) the size andshape of apertura sinus sphenoidalis, and its surrounding structures.5) the shape, walls,sinal septum of sinus sphenoidalis, types of gasification and the structural relationshipamong the ethomid-sphenoid, optical canal, internal carotid canal and cavernous sinus, paying more attention to the sphenethmoid onodi and sphenoidal ethmoidal cells.6) the sagittal and coronary diameter of hypophysial fossa:Based on the measurements mentioned above the simulation of transsphenoidalapproach was made.2On pictures of VR and MPR we measured:1) the distance from the root of thecolumella nasi to the basement of the apertura sinus sphenoidalis; the maximum coronarydiameter of sphenoid sinus, and the distance from the root of the columella nasi to theintersection of the maximum coronary diameter and the lateral wall of the sphenoid sinus.2) The elevation angle of Aeby’s plane to the line from the root of the columella nasi to thebasement of apertura sinus sphenoidalis, the angle of the median sagittal plane to theintersection of the maximum coronary diameter and the lateral wall of sphenoid sinus. thesagittal and coronary diameters of hypophysis, the thickness of sellar, and the distancefrom the sellar midpoint to anterior naris and to the apertura sinus sphenoidalis.Results:1Measurements from dissection as follwing:1) the vertical and the coronary diameter of the apertura sinus sphenoidalis is5.66±0.39,3.53±0.22mm in the right and5.60±0.36,3.61±0.20mm in the left；The distance from the apertura sinus sphenoidalis to postnaris, the end of middle nasalconcha and the end of middle nasal meatus is12.3±0.7,19.4±1.3，23.4±1.8mm in the right,and12.0±1.0,19.4±1.1,23.4±1.5mm in the left.2) The coronary, the vertical and sagittal diameter of the sphenoid sinus is17.5±6.1，20.3±7.3，20.7±7.4mm in the right,and18.4±9.0,22.1±9.0,22.1±9.0mm in the left.3) The distance from median line to the lateral wall of the sphenoid sinus is15.2±4.8mm in the right and14.8±4.8mm in the left.4) The distance from the apertura sinus sphenoidalis to the optic foramen, the internalorifice of internal carotid artery and to the dorsum sellae is11.6±1.8，13.7±2.2，14.6±3.0，22.6±3.2mm respectively.5) The sagittal and the coronary diameter of hypophysial fossa is10.2±1.5and14.0±2.4mm.6) The distance between anterior and posterior clinoid processes is25.0±3.0，15.8±3.3mm，and the distance from the anterior to the posterior and to the contralateral posteriorclinoid processes is7.8±1.7and21.8±2.4mm. 7) The thickness of sellar is2.13±1.85mm, the distance from the anterior naris to theapertura sinus sphenoidalis，the sellar midpoint is57.65±1.48,71.45±1.98mm，and thedistance between apertura sinus sphenoidalis and sellar midpoint is13.10±1.97mm.2. Measurements from Imaging1) The distance from the root of the columella nasi to the basement of apertura sinussphenoidalis is69.87±5.23mm，and to the intersection of the maximum coronary diameterof sphenoid sinus and the lateral wall of the sphenoid sinus is76.30±5.14mm.2) The elevation angle of Aeby’s plane to the intersection of the root of columella nasiand the basement of the apertura sinus is31.07±6.40°，and the angle of median sagittalplane to the meeting point of the maximum coronary diameter and the lateral of thesphenoid sinus is12.62±2.99°.3) Measurements from VR and MPR as following: the sagittal and coronary diametersof hypophysis is10.1±1.08，14.54±1.42mm，and the thickness of sellar is2.15±1.86mm，the distance from anterior naris to apertura sinus sphenoidalis,sellar midpoint is57.85±1.64,571.25±2.85mm，and the distance between apertura sinus sphenoidalis and sellar midpointis13.15±1.68mm.Conclusion1) We obtained the applied anatomic data benefit to the transsphenoidal approachfrom cadaveric heads dissection.2) We got the imaging data for transsphenoidal approach on VR and MPR frompatients.3) Analysis showed no statistical differences among data from VR and MPR imagingto those from dissecting the cadaveric heads, suggesting imaging data can serve as reliablemorphological references for the clinic.