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European Archives of... Dec 2023Inverted papilloma of the sphenoid sinus (IPSS) is a rare tumor with debated surgical management due to its proximity to vital structures. The aim of this manuscript is... (Review)
Review
PURPOSE
Inverted papilloma of the sphenoid sinus (IPSS) is a rare tumor with debated surgical management due to its proximity to vital structures. The aim of this manuscript is to highlight the role of a transpterygoid approach (TPA) and pedicle-orientated strategy in case of involvement of critical structures in IPSS and compare it with data from the literature.
METHODS
Patients with primary IPSS between January 2000 and June 2021 were included. Pre-operative CT/MRI were analyzed to classify the pneumatization of the SS and predict the insertion point of the inverted papilloma. All patients were treated with a trans-sphenoidal approach which was combined with a TPA in case of lateral insertion point. A systematic search was also performed to summarize the available literature.
RESULTS
Twenty-two patients were treated for IPSS. By CT, the SS was categorized with type III pneumatization in 72.8% of cases. Eleven patients (50%) were treated with a TPA with a statistical association with the insertion point on the SS lateral wall (p = 0.01), rather than a SS pneumatization (p = 0.63). The overall success was 95.5% after a mean follow-up of 35.9 months. For the literature, 26 publications were included on 97 patients and described a trans-sphenoidal approach with a success rate of 84.6% after a mean follow-up of 24.5 months.
CONCLUSION
IPSS is generally treated with a sphenoidotomy approach, although in selected cases, a TPA should be preferred to expose the whole SS lateral wall though allowing a complete pedicled oriented resection of the tumor.
Topics: Humans; Carcinoma; Endoscopy; Papilloma, Inverted; Paranasal Sinus Neoplasms; Sphenoid Sinus; Tomography, X-Ray Computed
PubMed: 37414940
DOI: 10.1007/s00405-023-08106-6 -
The Journal of Craniofacial SurgeryThe aim of this study is to verify if the length of the nasoseptal flap is sufficient to cover the tuberculum sellae and planum sphenoidale of sphenoidal sinuses with...
OBJECTIVE
The aim of this study is to verify if the length of the nasoseptal flap is sufficient to cover the tuberculum sellae and planum sphenoidale of sphenoidal sinuses with varied degrees of pneumatization.
METHODS
Retrospective study of paranasal sinus computed tomography comparing the potential length of the nasoseptal flap and the length of the nasoseptal flap required for reconstruction of transtuberculum and transplanum approaches in conchal, presellar, sellar, incomplete postsellar, and complete postsellar sphenoidal sinuses.
RESULTS
The length of the nasoseptal flap required for reconstruction of transtuberculum and transplanum approaches was directly related to the degree of pneumatization of the sphenoidal sinus. The nasoseptal flap length was adequate to cover the cranial base after transtuberculum approaches of all cases from the conchal, presellar, and sellar groups and the majority of cases from postsellar pneumatization. For transplanum approaches, the nasosseptal flap was sufficient to reconstruct defects in most cases from conchal, pre-sellar, and sellar type sinuses and in 54,9% and 19,2% in incomplete and complete postsellar, respectively.
CONCLUSIONS
In well pneumatized sphenoidal sinus, the nasoseptal flap may not be sufficient to cover the cranial base after transtuberculum and transplanum approaches.
Topics: Humans; Retrospective Studies; Sphenoid Sinus; Skull Base; Paranasal Sinuses; Surgical Flaps
PubMed: 36409852
DOI: 10.1097/SCS.0000000000008690 -
World Neurosurgery Apr 2017The transsphenoidal approach is considered the gold standard for resection of pituitary adenomas and other sellar region lesions. This approach is guided by a few... (Review)
Review
BACKGROUND
The transsphenoidal approach is considered the gold standard for resection of pituitary adenomas and other sellar region lesions. This approach is guided by a few fundamental anatomic landmarks that conduct the surgeon toward the sellar floor. Some anatomic structures may vary a lot (e.g., intrasphenoidal septa, intercarotid distance) and may be difficult to identify. Pneumatization and conformation of the sphenoidal sinus (SS) plays a key role in accessing the floor of the sella and other skull base structures. A poorly pneumatized SS may be a relative contraindication to the transsphenoidal approach. We analyzed outcome and complications in transsphenoidal surgery for sellar lesions with a difficult SS.
METHODS
We analyzed 243 consecutive patients who underwent a transsphenoidal approach for sellar lesions. Patients with poor pneumatization of the SS were included. Neurosurgical and endocrinologic outcomes were reported.
RESULTS
Successful treatment using a transsphenoidal approach with neuronavigation and Doppler ultrasound was achieved in 15 patients with a low degree of pneumatization of the SS. A pituitary adenoma was present in 13 of 15 patients. Endocrinologic and neurosurgical outcomes were similar to patients with normal pneumatization of the SS, showing a cure of disease in 6 of 9 patients with functioning adenomas and an improvement of symptoms in cases of nonfunctioning adenomas.
CONCLUSIONS
Patients with a poorly pneumatized SS can be treated safely with a transsphenoidal approach using image guidance techniques to avoid major neurovascular complications.
Topics: Adult; Aged; Aged, 80 and over; Granulomatosis with Polyangiitis; Humans; Meningioma; Middle Aged; Neuronavigation; Pituitary Diseases; Pituitary Neoplasms; Sella Turcica; Skull Base; Sphenoid Sinus
PubMed: 28065874
DOI: 10.1016/j.wneu.2016.12.123 -
Journal of Neurosurgery. Pediatrics May 2013
Topics: Encephalocele; Female; Humans; Male; Neurosurgical Procedures; Palate; Sphenoid Sinus
PubMed: 23495809
DOI: 10.3171/2012.12.PEDS12454 -
European Archives of... May 2023Accessory sphenoidal septum (ASS) is a septal variation that exists in addition to the primary septum of the sphenoid sinus and can be found in or near anatomically...
PURPOSE
Accessory sphenoidal septum (ASS) is a septal variation that exists in addition to the primary septum of the sphenoid sinus and can be found in or near anatomically essential structures. This study aimed to investigate the relationships between protrusions of vital structures around the sphenoid sinus and the ASSs.
METHODS
This cross-sectional retrospective study is based on the analysis of CBCT scans of 314 patients in axial, coronal, and sagittal planes with 0.2-0.3 slice thicknesses. Optic nerve (ON), internal carotid artery (ICA), both ON and ICA, maxillary nerve (MN), vidian canal (VN) and ASSs were detected, and the relationship between protrusions of these vital anatomical structures and ASS was evaluated.
RESULTS
Statistically significant relationship was observed between the right Type 1 ON protrusion (p < 0.05) and left Type 1 ON protrusion (p = 0.001); left Type 3 ON protrusion (p < 0.05); right Type 4 ON protrusion (p < 0.05) and ASS. Statistically significant relationship was also observed between the right ICA protrusion and ASS (p < 0.05). The right Type 1 VN protrusion (p = 0.001); left Type 2 VN protrusion (p < 0.001); right and left Type 3 VN protrusions (p < 0.001) were found to be significantly associated with the ASS.
CONCLUSIONS
ASSs have significant associations with some protrusions, and they tend to cause potentially severe complications in endoscopic sinus surgery. This variability requires a comprehensive understanding of regional sphenoid sinus anatomy with detailed three-dimensional tomographic imaging.
Topics: Humans; Cross-Sectional Studies; Retrospective Studies; Sphenoid Bone; Sphenoid Sinus; Tomography, X-Ray Computed
PubMed: 36534215
DOI: 10.1007/s00405-022-07780-2 -
Steroids Feb 2020Ectopic thyrotropin-secreting pituitary adenomas are rare, with only 10 published cases. We report the case of a 52-year-old woman who was referred for primary... (Review)
Review
Ectopic pituitary adenoma of the TSH-secreting sphenoidal sinus with excellent response to somatostatin analogs. Theory of the embryogenesis and literature review from a clinical case.
Ectopic thyrotropin-secreting pituitary adenomas are rare, with only 10 published cases. We report the case of a 52-year-old woman who was referred for primary hypothyroidism, who showed clinical signs of hyperthyroidism and had been under treatment with levothyroxine. Her exams revealed high levels of thyroid stimulating hormone (TSH), at odds with free thyroxin (FT4) and raised triiodothyronine (T3), which remained elevated after medication suspension, suggesting possible central hyperthyroidism. Sellar MRI showed normal pituitary gland, with a mass in the sphenoid sinus of 24 mm. A possible ectopic TSH secreting pituitary tumor of sphenoid sinus was hypothesized. After a intramuscularly (IM) single dose of a sustained-relase of a somatostatin analog (octreotide) 20 mg, plasma levels of thyroid hormones were normalized and a significant tumor reduction was demonstrated in MRI control at 7-weeks' follow-up. The tumor was removed by transsphenoidal endoscopy, and the biopsy confirmed an adenoma with positive immunostaining for TSH and GH. Hyperthyroidism recurrence was observed in hormonal controls 4 weeks after surgery. Treatment with sustained-release octreotide was reinitiated, every 60-days for two years, with normalization of the thyroid hormone profile, but with a residual lesion with the appearance of a tumor in the MRI. A second tumor resection was performed, achieving sustained hormonal cure and no residual tumor lesion at 2-years' follow-up. To our knowledge, this is the first report of an ectopic thyrotropin-secreting pituitary adenoma of the sphenoid sinus. Clinical and laboratory aspects relevant to this entity are reviewed, emphasizing the usefulness of octreotide in the management of the reported case.
Topics: Female; Humans; Hyperthyroidism; Magnetic Resonance Imaging; Middle Aged; Octreotide; Pituitary Gland; Pituitary Neoplasms; Sphenoid Sinus; Thyrotropin
PubMed: 31704334
DOI: 10.1016/j.steroids.2019.108535 -
Neurologia Medico-chirurgica Jun 2000Malignant melanomas arising from the sella turcica or sphenoidal sinus with bilateral invasion of the base of the skull or cavernous sinus are extremely rare. Whether... (Review)
Review
Malignant melanomas arising from the sella turcica or sphenoidal sinus with bilateral invasion of the base of the skull or cavernous sinus are extremely rare. Whether the sella turcica or sphenoidal sinus is the site of origin is difficult to determine based on neuroradiological findings. An 83-year-old Japanese female presented with headache as the initial symptom. She suffered rapid progression of bilateral obstruction of the nasal cavity, left nasal bleeding, and bilateral visual field defects. The preoperative diagnosis was pituitary adenoma, metastatic tumor, or malignant paranasal tumor. Biopsy was performed. The histological diagnosis was malignant melanoma. Postoperatively, the tumor progressed rapidly. She suffered several cranial nerve pareses and hypopituitarism. She died within 6 months. Tumors arising from the sphenoidal sinus cause obstruction of the nasal cavity or nasal bleeding first, and then cause cranial nerve pareses by invasion of the cavernous sinus. This sequence of clinical manifestations can be attributed to the anatomical relationships between the sphenoidal sinus, nasal cavity, and cavernous sinus. Differential diagnosis of the origin in the sella turcica or sphenoidal sinus appears to be relatively easy based on further observation of the clinical course and symptoms.
Topics: Aged; Aged, 80 and over; Biopsy; Brain Neoplasms; Fatal Outcome; Female; Humans; Melanoma; Multiple Organ Failure; Sella Turcica; Sphenoid Sinus
PubMed: 10892271
DOI: 10.2176/nmc.40.329 -
Journal of Forensic and Legal Medicine Jan 2021The determination of sex from skeletal remains has been widely used in biological profile reconstruction since these are some of the last structures to perish after...
The determination of sex from skeletal remains has been widely used in biological profile reconstruction since these are some of the last structures to perish after death. The sphenoid sinus is located deeply in the skull and is enveloped by diverse structures within the sphenoid body. It is, therefore, less predisposed to injuries and/or pathological changes. The aim of this study is to evaluate the possibility of determining sex in a Brazilian population by means of linear and volumetric measurements of the sphenoid sinus, in addition to identifying and quantifying the presence of extensions of this sinus in cone beam computed tomography (CBCT) scans. In total 268 CBCT scans were analysed, from patients aged between 22 and 70 years old, of which 145 were female, and 123 were male. The images, representative of a Brazilian population, were selected by a dental radiologist from a CBCT image bank. The volumetric measurements were made by means of the segmentation software ITK-SNAP 3.0® and the linear inferio-superior, latero-lateral and anteroposterior measurements, as well as the presence of extensions of the sphenoidal sinus, were made using the CS Imaging Software®. The results of this study suggested that when comparing men and women, there were no statistical differences in the linear measurements and extensions of the sphenoidal sinus, although the values were considerable in the extensions for the pterygoid processes and greater wings of the sphenoid bone, particularly in women. However, there was a statistically significant difference when the sphenoidal sinus volume was compared, as it was larger for men (11.364 mm³ ± 4.229 mm³) than for women (10.000 mm³ ± 3.615 mm³). In summary, the sphenoidal sinus volumetric measurements in CBCT exams are useful for determining the sex of unknown individuals.
Topics: Adult; Aged; Brazil; Cone-Beam Computed Tomography; Female; Forensic Anthropology; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Male; Middle Aged; Sex Determination by Skeleton; Sphenoid Sinus; Young Adult
PubMed: 33310643
DOI: 10.1016/j.jflm.2020.102097 -
Head & Neck Surgery 1982This article describes the complex anatomy of the sphenoid bone. The development and size of the sphenoidal sinuses are quite variable and complete analysis of the sinus...
This article describes the complex anatomy of the sphenoid bone. The development and size of the sphenoidal sinuses are quite variable and complete analysis of the sinus walls requires several views. The essential plain film projections and use of tomography and CT scans are described. Sphenoidal sinus inflammatory disease produces changes similar to those already discussed in the articles in this series on the frontal sinus and the ethmoidal sinus. Illustrations of sphenoidal sinus inflammatory disease are provided.
Topics: Humans; Sinusitis; Sphenoid Bone; Sphenoid Sinus; Tomography, X-Ray Computed
PubMed: 7169334
DOI: 10.1002/hed.2890050212 -
Acta Neurochirurgica Sep 2015Simultaneous appearance of sphenoid sinus aspergilloma and pituitary adenoma is a very rare finding.
BACKGROUND
Simultaneous appearance of sphenoid sinus aspergilloma and pituitary adenoma is a very rare finding.
METHODS
Retrospective analysis of patients with sellar and sphenoid sinus mass lesions who underwent trans-sphenoidal surgery was performed. Demographic data, medical history, predisposing factors, clinical picture, neurological status and radiological findings were reviewed. All patients underwent a trans-sphenoidal microsurgical treatment, and acquired specimens underwent both histopathological and microbiological analysis.
RESULTS
Sphenoid sinus aspergilloma was encountered in seven patients. Three patients had an isolated sphenoid sinus aspergilloma and four patients with pituitary macroadenoma had a sphenoid aspergilloma as an incidental finding.
CONCLUSIONS
Sphenoid sinus aspergilloma can be found during trans-sphenoidal surgery for pituitary adenomas. Sphenoid sinus extirpation followed by adenomectomy is the treatment of choice unless invasive aspergilloma is encountered requiring additional antifungal therapy.
Topics: Adenoma; Aged; Aged, 80 and over; Antifungal Agents; Aspergillosis; Aspergillus; Comorbidity; Female; Humans; Incidental Findings; Male; Middle Aged; Pituitary Neoplasms; Retrospective Studies; Sphenoid Bone; Sphenoid Sinus; Treatment Outcome
PubMed: 26126762
DOI: 10.1007/s00701-015-2485-6