Langerhans cell histiocytosis of the sella in a pediatric patient: case report with review of the literature.

PURPOSE: Langerhans cell histiocytosis (LCH) is a rare condition arising from the monoclonal expansion of myeloid precursor cells, which results in granulomatous lesions that characteristically express CD1a/CD207. We report a case of LCH in a 3-year-old male involving the sphenoid bone with extension into the sellar/suprasellar region. CASE REPORT: A 3-year-old male presented with progressively worsening headaches and associated night sweats, neck stiffness, and fatigue over the previous 4 weeks. Magnetic resonance imaging (MRI) revealed a 2.4-cm lytic lesion within the basisphenoid, exerting mass effect upon the pituitary gland. A biopsy was performed to determine the etiology of the lesion. Postoperatively, the patient developed an intralesional hematoma with visual complications requiring emergent surgical resection via endoscopic endonasal approach. Final pathology confirmed LCH. The patient had improvement in his vision long term. CONCLUSIONS: LCH extending into the sella is a rare but important diagnosis to consider in pediatric patients presenting with lesions in this region. We presented a case of a pediatric patient presenting with LCH of the sphenoid bone extending into the sella, with subsequent apoplexy and vision loss. Review of the literature showed varying treatment options for these patients, including purely surgical and non-surgical treatments. Early intervention may be necessary to avoid potentially devastating neurologic sequelae.

Factors influencing postoperative visual improvement in 208 patients with tuberculum sellae meningiomas.

OBJECTIVE: Tuberculum sellae meningiomas (TSMs) usually compress the optic nerve and optic chiasma, thus affecting vision. Surgery is an effective means to remove tumors and improve visual outcomes. On a larger scale, this study attempted to further explore and confirm the factors related to postoperative visual outcomes to guide the treatment of TSMs. METHODS: Data were obtained from 208 patients with TSMs who underwent surgery at our institution between January 2010 and August 2022. Demographics, ophthalmologic examination results, imaging data, extent of resection, radiotherapy status, and surgical approaches were included in the analysis. Univariate and multivariate logistic regressions were used to assess the factors that could lead to favorable visual outcomes. RESULTS: The median follow-up duration was 63 months, and gross total resection (GTR) was achieved in 174 (83.7%) patients. According to our multivariate logistic regression analysis, age < 60 years (odds ratio [OR] = 0.310; P = 0.007), duration of preoperative visual symptoms (DPVS) < 10 months (OR = 0.495; P = 0.039), tumor size ≤ 27 mm (OR = 0.337; P = 0.002), GTR (OR = 3.834; P = 0.006), and a tumor vertical-to-horizontal dimensional ratio < 1 (OR = 2.593; P = 0.006) were found to be significant independent predictors of favorable visual outcomes. CONCLUSION: Age, DPVS, tumor size, GTR, and the tumor vertical-to-horizontal dimensional ratio were found to be powerful predictors of favorable visual outcomes. This study may help guide decisions regarding the treatment of TSMs.

Solitary isolated disseminations of glioblastoma to sellar and suprasellar regions: two case reports.

Herein, we present two cases of isolated suprasellar dissemination of glioblastoma in patients with well-controlled primary lesions. A 22-year-old woman and a 56-year-old woman developed rapid growth of suprasellar glioblastoma dissemination 26 and 17 months after initial surgery, respectively. Both patients presented with acute visual impairment (decreased acuity and visual field disturbances) but lacked severe pituitary dysfunction. During surgery for the disseminated tumors, gross total tumor resection was difficult due to intraoperative findings suggesting optic pathway invasion. Both patients developed further intracranial dissemination within several months post-surgery. The presence of solitary sellar and suprasellar dissemination may indicate a terminal stage.

How successful is the CatBoost classifier in diagnosing different dental anomalies in patients via sella turcica and vertebral morphologic alteration?

BACKGROUND: To investigate how successfully the classification of patients with and without dental anomalies was achieved through four experiments involving different dental anomalies. METHODS: Lateral cephalometric radiographs (LCRs) from 526 individuals aged between 14 and 22 years were included. Four experiments involving different dental anomalies were created. Experiment 1 included the total dental anomaly group and control group (CG). Experiment 2 only had dental agenesis and a CG. Experiment 3 consisted of only palatally impacted canines and the CG. Experiment 4 comprised patients with various dental defects (transposition, hypodontia, agenesis-palatally affected canine, peg-shaped laterally, hyperdontia) and the CG. Twelve sella measurements and assessments of the ponticulus posticus and posterior arch deficiency were given as input. The target was to distinguish between anomalies and controls. The CatBoost algorithm was applied to classify patients with and without dental anomalies. RESULTS: In order from lowest to highest, the predictive accuracies of the experiments were as follows: experiment 4 < experiment 2 < experiment 3 < experiment 1. The sella area (SA) (mm2) was the most important variable in experiment 1. The most significant variable in prediction model of experiment 2 was sella height posterior (SHP) (mm). Sella area (SA) (mm2) was again the most relevant variable in experiment 3. The most important variable in experiment 4 was sella height median (SHM) (mm). CONCLUSIONS: Every prediction model from the four experiments prioritized different variables. These findings may suggest that related research should focus on specific traits from a diagnostic perspective.

Congenital trans-sellar trans-sphenoidal encephalocele: a systematic review of diagnosis, treatment, and prognosis.

PURPOSE: Clinical presentations encompass respiratory, feeding issues, nasopharyngeal mass, meningitis, CSF leakage, craniofacial anomalies, and endocrine problems. Surgery is the primary treatment, transitioning from frontal craniotomy to endoscopic methods, offering improved outcomes. Yet, more studies are needed. A comprehensive review on trans-sellar trans-sphenoidal encephalocele (TSTSE) is missing. Our study aims to fill this gap, offering a comprehensive perspective for physicians. METHODS: This review adhered to the PRISMA guideline. Eligible studies focused on human subjects, specifically trans-sellar encephaloceles, and provided comprehensive treatment details. English language articles published up to April 11th, 2023, were considered. Two trained researchers conducted article screening using consistent criteria. Data extraction covered various aspects, including clinical presentation, surgical methods, and outcomes, with results presented descriptively in two tables. Due to the rarity of this congenital anomaly, meta-analysis and publication bias assessment were not feasible. Data extraction was independently conducted by two reviewers, with subsequent cross-verification. RESULTS: A total of 36 patients were identified from 14 studies, the most frequently observed clinical presentation was dyspnea (41.67%) and the most frequently observed accompanying anomaly was cleft lip/palate (55.56%). CT and MRI were adopted in nearly all the cases, and trans-nasal approach was the most often used surgical approach (57.14%) with the 'soft material combination' the most commonly used method for cranial base repairment (35.71%). A total of two deaths occurred and diabetes insipidus was the most common perioperative complication which occurred in six surgery patients (21.43%). CONCLUSION: TSTSE predominantly affects males and presents with dyspnea, visual deficits, pituitary insufficiency, and cranial base-related symptoms. Early diagnosis is critical, with advanced imaging playing a key role. Endocrine assessment is vital for hormone management. Surgery offers symptom relief but entails risks, including reported fatalities and complications. The choice between surgery and conservative management requires careful deliberation. The trans-nasal approach is favored for its reduced trauma, yet further research is necessary to validate this preference.

The relationship between sphenoidal sinus and sella turcica morphometry in the Turkish population: a retrospective study.

PURPOSE: The anatomical position of the sphenoidal sinus (SS) is very important for neurosurgeons because of the transsphenoidal approach to the pituitary gland. Therefore, the aim of this study was to determine the volume and shape of the SS and its relationship with the morphometry of the sella turcica. METHODS: This study included CT images of 282 males and 258 females with a mean age of 50.52 years (range 18-75) who underwent head CT. The morphometric values of the sella turcica and the volume of the SS were measured on the included radiologic images. Measurements were made on the sagittal slice closest to the midline in T1 sequence. Morphometric measurements were made with Micro Dicom Viewers software program and volume measurements were made with ITK SNAP software program. RESULTS: In this study, 4 types of SS shapes were obtained in the whole population: amorphous, pentagonal, triangular and quadrilateral. The mean SS volume was 7055.88 mm3 in males and 5694.48 mm3 in females and a statistically significant difference was observed (p < 0.001). In addition, a statistically significant difference was found between the sexes in the width and surface area parameters of the sella turcica (p < 0.05). CONCLUSION: In this study, the morphometric relationship between the shape of the sinus sphenoidale and sella turcica was demonstrated between men and women. In particular, the shape of the sinus sphenoidale was found to be anthropometrically different between men and women in the Turkish population. It is hypothesised that the data obtained in our study will guide surgeons performing transsphenoidal approach.

Retrospective analysis of the upper airway anatomy and Sella turcica morphology across different skeletal malocclusions: a computerized technique.

OBJECTIVE: This study aimed to investigate the normal volumetric space and variations in the measurements of different landmarks in adults with different skeletal relations of the maxilla and the mandible based on CBCT data. The study also analyses these landmarks to locate any correlations. BACKGROUND: Numerous studies in orthodontics have found a relationship between orthodontic treatment and changes in the anatomy and function of the airway. Severe changes in airway morphology can cause breathing difficulties, lower quality of life, and even result in life-threatening conditions such as obstructive sleep apnoea. Consequently, orthodontic diagnosis and treatment planning require a thorough understanding of the airway space and its function. METHODS: The present retrospective study was conducted using CBCT records of 120 adult patients, containing 40 samples of each skeletal class (20 males and 20 females). The boundaries were defined for the 3 major regions: the nasopharynx, the oropharynx, and the hypopharynx. Various measurements were recorded across these regions, as well as selective cephalometric landmarks. The obtained data was used to calculate average and standard deviation, while regression analysis was used to evaluate correlations and t-test was used to test statistical significance of gender differences. RESULTS: The results demonstrate that skeletal Class III individuals exhibit a reduced airway volume in the nasopharynx compared to other groups, whereas skeletal Class II individuals displayed a diminished airway volume in the hypopharynx. A strong correlation was observed for Sella turcica parameters. There were no significant differences in skeletal parameters across genders. Nasopharynx cavity volume demonstrated significant differences between skeletal Class I-Class III as well as between skeletal Class II-Class III. Hypopharynx cavity volume also demonstrated significant differences between skeletal Class I-Class II and between skeletal Class II-Class III. CONCLUSION: The major findings are the presence of a reduced nasopharyngeal volume in skeletal Class III malocclusions while skeletal Class II individuals displayed a diminished hypopharyngeal volume, making these critical areas to consider during the diagnostic and orthodontic treatment planning stages. This study also revealed a consistent correlation between Sella turcica parameters across various facial skeletal profiles, with skeletal Class II patients exhibiting a distinct pattern and skeletal Class I and Class III demonstrating an average relationship.

[Preoperative Simulation of Endoscopic Endonasal Approach for Craniopharyngiomas or Tuberculum Sellae Meningiomas].

Preoperative simulation for endoscopic endonasal approach(EEA)using computed tomography and magnetic resonance imaging evaluates tumor extension and the relationship between adjacent structure(the pituitary stalk, major vessels, and cranial nerves); therefore, preoperative planning of nasal procedure, skull base bony removal, and cranial base reconstruction are possible. Additionally, three-dimensional(3D)fusion image aids surgeons to visualize intraoperative 3D findings. These preoperative simulations are critical to avoid complications and predict pitfalls perioperatively. However, tumor consistency or adhesion with adjacent structure cannot be predicted but is judged perioperatively, which affects the extent of tumor resection. This manuscript describes important points of preoperative simulation for EEA, especially the transplanum-transtuberculum approach for craniopharyngiomas or tuberculum sellae meningiomas, showing some examples in patients.

Neoplasms and tumor-like lesions of the sellar region: imaging findings with correlation to pathology and 2021 WHO classification.

The sellar region represents a complex anatomical area, composed of multiple structures of different embryological derivation, including the skull base and the pituitary gland, along with vascular, nervous, and meningeal structures. Masses arising in this region include benign and malignant lesions arising from the pituitary gland itself, but also from vestigial embryological residues or surrounding tissues, that may require different therapeutic approaches. While assessing sellar region masses, the combination of clinical presentation and imaging features is fundamental to define hypotheses about their nature. MR represents the imaging modality of choice, providing information about the site of the lesion, its imaging features, and relation with adjacent structures, while CT is useful to confirm the presence of lesion calcifications or to reveal tumor invasion of bony structures. The aim of this pictorial review is to provide an overview of the common neoplasms and tumor-like conditions of the sellar region, according to the 2021 WHO Classification of Tumors of the Central Nervous System (fifth edition), with an emphasis on the radiologic-pathologic correlation. After a brief introduction on the anatomy of this region and the imaging and pathological techniques currently used, the most relevant MRI characteristics, clinical findings, and pathological data, including histologic and molecular features, will be shown and discussed, with the aim of facilitating an appropriate differential diagnosis among these entities.

Deep learning-based automatic sella turcica segmentation and morphology measurement in X-ray images.

BACKGROUND: Although the morphological changes of sella turcica have been drawing increasing attention, the acquirement of linear parameters of sella turcica relies on manual measurement. Manual measurement is laborious, time-consuming, and may introduce subjective bias. This paper aims to develop and evaluate a deep learning-based model for automatic segmentation and measurement of sella turcica in cephalometric radiographs. METHODS: 1129 images were used to develop a deep learning-based segmentation network for automatic sella turcica segmentation. Besides, 50 images were used to test the generalization ability of the model. The performance of the segmented network was evaluated by the dice coefficient. Images in the test datasets were segmented by the trained segmentation network, and the segmentation results were saved in binary images. Then the extremum points and corner points were detected by calling the function in the OpenCV library to obtain the coordinates of the four landmarks of the sella turcica. Finally, the length, diameter, and depth of the sella turcica can be obtained by calculating the distance between the two points and the distance from the point to the straight line. Meanwhile, images were measured manually using Digimizer. Intraclass correlation coefficients (ICCs) and Bland-Altman plots were used to analyze the consistency between automatic and manual measurements to evaluate the reliability of the proposed methodology. RESULTS: The dice coefficient of the segmentation network is 92.84%. For the measurement of sella turcica, there is excellent agreement between the automatic measurement and the manual measurement. In Test1, the ICCs of length, diameter and depth are 0.954, 0.953, and 0.912, respectively. In Test2, ICCs of length, diameter and depth are 0.906, 0.921, and 0.915, respectively. In addition, Bland-Altman plots showed the excellent reliability of the automated measurement method, with the majority measurements differences falling within ± 1.96 SDs intervals around the mean difference and no bias was apparent. CONCLUSIONS: Our experimental results indicated that the proposed methodology could complete the automatic segmentation of the sella turcica efficiently, and reliably predict the length, diameter, and depth of the sella turcica. Moreover, the proposed method has generalization ability according to its excellent performance on Test2.

Unexpected concomitant pituitary adenoma and suprasellar meningioma: a case report and review of the literature.

We report a case of a 75-year-old patient with hypopituitarism, bitemporal visual field deficits and a parasellar mass on pituitary MRI. During surgery, suspicion was raised that a non-functioning pituitary adenoma was accompanied by an abutting diaphragm sellae meningioma, which was confirmed at pathological examination. In retrospect, the initial MRI suggested two separate tumours on the basis of differing densities but this distinction was not seen on the last preoperative MRI.

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

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.

Nasal and Sellar Anatomic Variations in Pituitary-Dependent Cushing Disease.

OBJECTIVE: Adrenocorticotrophic hormone excessive secretion in pituitary-dependent Cushing disease (CD) patients may lead to anatomic variations of the nasal-sphenoidal corridor as a result of hormone-induced abnormal soft tissue change. However, there is still a lack of data on anatomic dimensions in CD patients. In this study, magnetic resonance images were analyzed to determine the anatomic variations of the nasal cavity and sphenoid sinus in CD patients. METHODS: A retrospective radiographic analysis was conducted on CD patients undergoing endonasal transsphenoidal surgery as primary treatment between January 2013 and December 2017. A total of 97 CD patients and 100 controls were included. The nasal and sphenoidal anatomic dimensions of CD patients were compared with the control group. RESULTS: Both sides of nasal cavity height, middle nasal meatus width, and inferior nasal meatus width in CD patients were narrower than that of controls. When compared with controls, the ratio of the middle turbinate to middle nasal meatus and the ratio of inferior turbinate to inferior nasal meatus was found to increase on both sides in CD patients. Intercarotid distance of CD patients was shorter than that of controls. The most prevalent pneumatization pattern of CD patients was postsellar, followed by sellar, presellar, and conchal. CONCLUSIONS: Cushing disease patients have nasal and sphenoidal anatomic variations affecting the endonasal transsphenoidal surgical corridor, especially the shorter intercarotid distance. The neurosurgeon should be aware of these anatomic variations, and adapt surgical techniques and optimal approaches to reach the sella safely.

Evaluation of Dimension and Bridging of Sella Turcica and Presence of Ponticulus Posticus in Individuals With and Without Cleft: A Comparative Study.

OBJECTIVE: Sella turcica abnormalities such as sella turcica bridging (STB) have been observed frequently among patients with craniofacial anomalies. Ponticulus posticus (PP) is an important structure and its presence causes complications during surgeries. Due to the importance of these structures, this study aimed to evaluate the prevalence of STB, PP, and dimensions of the sella turcica in individuals with and without cleft. DESIGN: A cross-sectional study. SETTING: Orthodontic and Radiology Departments in a public dental school, Tehran, Iran. PATIENTS: Eighty-three lateral cephalograms of individuals with cleft and ninety-two cephalograms of class I individuals without cleft. MAIN OUTCOME MEASURES: Length, depth, and maximum anterior-posterior diameter (APD) of sella turcica, presence of STB (classified as types 1, 2, and 3), and PP. RESULTS: In the group with cleft, 19.3% of individuals had type I, 65.1%, type II, and 15.7%, type III STB. In the group without cleft, 15.2% had type I, 73.9%, type II, and 10.9%, type III STB. In the group with cleft, 65.1% of individuals had no PP, 24.1%, incomplete, and 10.8%, complete PP while in the group without cleft, 56.5% had no PP, 29 31.5%, incomplete, and 12%, complete PP. CONCLUSION: The sella turcica dimensions, STB, and PP prevalence were not significantly different between individuals with and without cleft. The sella turcica length and prevalence of STB and PP were not affected by age, sex, and cleft type. However, the depth and the APD were affected by age.

Association between sella turcica bridging and the impaction severity of palatally displaced canines: A retrospective study.

INTRODUCTION: This retrospective study aimed to investigate the association between the extent of the bridging and dimensions of sella turcica and the impaction severity of palatally displaced canines. Secondarily, any possible association between skeletal age and gender was evaluated. METHODS: Panoramic and cephalometric radiographs of 94 patients (63 female, 31 male; 19 pre-peak, 75 post-peak) with palatally displaced canines were evaluated. Sector classification and α angle were used to determine the impaction severity of palatally displaced canines on panoramic radiographs. The distance from the cusp tip of the palatally displaced canines to the occlusal plane (d) and the extent of the bridging and dimensions of the sella turcica were evaluated on cephalometric radiographs. RESULTS: Sella turcica bridging and dimensions did not vary regarding the impaction severity of palatally displaced canines, but a significant association was found between sella turcica bridging and skeletal age (P = 0.038). Class II (33.3%) and Class III (12.0%) bridging was higher in postpubertal patients. No differences between females and males were detected for the extent of bridging and dimensions of the sella turcica. CONCLUSIONS: These findings indicate no association between sella turcica bridging and dimensions and the impaction severity of palatally displaced canines. Sella turcica bridging is more frequent in the postpubertal period, whereas gender does not influence sella turcica bridging. More studies are needed to evaluate if the extent of sella turcica bridging may be indicative of severely impacted palatal canines, which in turn would allow for careful monitoring of patients from an early age and for the clinician to take preventive measures.

Sella turcica variations in patients with transverse skeletal discrepancies versus patients with normal transverse relationships. a cross- sectional study.

BACKGROUND: The sella turcica (ST) is a crucial landmark in orthodontics. It is utilized as a reliable predictor of future growth of the skeletal pattern, assisting in early diagnosis and promoting better treatment planning options. The goal of this research was to compare the morphology and bridging of the sella turcica in transverse maxillary deficient malocclusions and malocclusions with normal transverse relationships. METHODS: A total of 52 cone beam computed tomographic (CBCT) images were selected with an age range of 18-30 years. Group I comprised 26 patients previously diagnosed with transverse maxillary deficiency, while group II comprised 26 patients with normal transverse skeletal relationships. The length, depth and diameter of the ST were measured by two observers, the shape was evaluated as round, oval or flat and sellar bridging was calculated in each case. An Independent t-test was used to compare between the sellar dimensions in both groups. For assessment of bridging percentage Chi square test was used. RESULTS: The mean values of the length, depth and diameter of the sella in group I was 11.09 mm, 8.56 and 12.81 mm respectively and 10.34 mm, 8.24 and 12.38 mm in group II respectively (P ≤ 0.05). No significant differences were found between both groups in any of the sellar dimensions. The rounded ST shape was the most prevalent among both groups (59.6%). Partial ST bridging was found in only 7.7% of group I (p < 0.0001*). Complete ST bridging wasn't detected in either of the groups. CONCLUSIONS: There was no correlation found between transverse maxillary deficiency and the morphology and bridging of the sella turcica.

Morphological types of sella turcica bridging and sella turcica dimensions in relation to palatal canine impaction: a retrospective study.

The aim of this study was to determine the relationship between the presence of sella turcica bridging and palatal canine impaction (PCI) using several classification methods. In this retrospective study, lateral cephalometric radiographs of 120 subjects with PCI (43 males, 77 females; mean age 18.8 ± 7.8 years) and 120 controls (44 males, 76 females; mean age 18.1 ± 5.6 years) with complete permanent dentition were examined. The extent of sella turcica bridging was assessed using two different methods, and the types of complete sella turcica bridging were evaluated. The sella turcica dimensions were measured and analyzed using the t-test, and comparison of the presence of sella turcica bridging was performed using the two-tailed Fisher's exact test. The frequency of complete sella turcica bridging was significantly higher in subjects with PCI (18.3%) than in controls (8.3%, p = 0.023) but without significant differences in the occurrence of sella turcica bridging of Type A (ribbon-like fusion) and Type B (extension of clinoid processes). No significant differences in partial bridging were found between patients with PCI and controls according to both methods. The length and the anteroposterior diameter were significantly larger in subjects with PCI and no difference was observed between the groups in the sella turcica depth. Complete sella turcica bridging occurred significantly more frequently in subjects with PCI than in controls. However, the association between partial bridging and PCI was not confirmed, therefore, we do not recommend any classification of partial bridging for clinical practice.

Case 299: Sellar Spine.

History Part one of this case appeared 4 months previously and may contain larger images. A 32-year-old woman presented to an ophthalmologist for bilateral blurry vision. She underwent MRI of the brain and orbits, which showed a focal abnormality within the pituitary gland. The patient was referred to an endocrinologist for further evaluation. Review of systems and physical examination by the endocrinologist revealed no symptoms or signs of endocrine dysfunction. Anterior pituitary hormone levels, including growth hormone, prolactin, thyroid stimulating hormone, follicular-stimulating hormone, luteinizing hormone, and adrenocorticotropic hormone, were normal. Dynamic contrast-enhanced MRI of the sella and pituitary gland and subsequent CT of the anterior skull base were performed.

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

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.

How I do it: optic canal unroofing in surgery for tuberculum sellae meningiomas with compression of the optic nerve.

BACKGROUND: Tuberculum sellae meningiomas are challenging to treat when accompanied with altered vision due to compression of the optic nerve. These tumors mostly refer to be benign; therefore, gross total removal and excellent functional recovery are desired. METHOD: We describe the microsurgical treatment of tuberculum sellae meningioma with altered vision function on the left eye. Intradural unroofing of the optic canal with gross total resection of the tumor led to immediate excellent recovery. Intraoperative video highlights key steps of our surgical approach. CONCLUSION: Optic canal unroofing is in our opinion safe and mandatory when treating tuberculum sellae meningiomas with compression of optic nerve.