Anatomical Differences in Sphenoid Sinus During Endoscopic Transsphenoidal Surgery: Comparison Between Nonfunctioning Pituitary Neuroendocrine Tumor (PiTNET) and Growth Hormone-Secreting PiTNET

Aug 8, 2024World neurosurgery

Anatomy differences in the sinus area during surgery for nonactive versus growth hormone-producing pituitary tumors

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Abstract

The intercarotid distance in patients with GH-secreting pituitary tumors is 16.8 mm, significantly smaller than the 20.4 mm observed in nonfunctioning pituitary tumors.

Patients with GH-secreting pituitary tumors showed reduced intercarotid distance, largest diameter of the sphenoid sinus, and distance between vomer and clivus compared to those with nonfunctioning tumors.
Intercarotid distance was 16.8 ± 3.94 mm for GH-secreting tumors versus 20.4 ± 3.94 mm for nonfunctioning tumors, indicating a narrower surgical field.
The largest diameter of the sphenoid sinus was smaller in the GH-secreting group (32.5 ± 9.81 mm) compared to the nonfunctioning group (38.6 ± 11.03 mm).
The distance between vomer and clivus was also significantly less in the GH-secreting group (25.5 ± 6.96 mm) than in the nonfunctioning group (29.6 ± 8.47 mm).
No differences were noted in the presence or characteristics of the intersphenoid sinus septum between the two groups.

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BACKGROUND: In surgical practice during endoscopic endonasal approach, growth hormone-secreting pituitary neuroendocrine tumor (GH-secreting PitNET) patients show morphologic differences in the nasal cavities and sinuses, leading to a narrower surgical field and a carotid prominence and potentially increasing the complexity of the surgical and the risk of complications. The aim of the study is to evaluate the anatomical differences of the sphenoid sinus between patients with GH-secreting PitNETs and patients with nonfunctioning pituitary neuroendocrine tumor (NF-PitNET) who underwent endoscopic endonasal approach.

METHODS: This is a monocentric retrospective study conducted at the author's institution. The minimum intercarotid distance, the largest diameter of the sphenoid sinus (DSS), and the distance between vomer and clivus (VCD) were collected and compared. Presence, localization, and course of intersphenoid sinus septum were also evaluated.

RESULTS: One hundred consecutive patients were identified: 57 males (57%) and 43 females (43%), with a mean age of 55 years. Sixty patients had NF-PitNET (60%) and 40 had GH-secreting PitNET (40%). GH-secreting PitNET group presented inferior values of intercarotid distance (16.8 ± 3.94 mm vs. 20.4 ± 3.94 mm, P < 0.001), DSS (32.5 ± 9.81 mm vs. 38.6 ± 11.03 mm, P = 0.006), and VCD (25.5 ± 6.96 mm vs. 29.6 ± 8.47 mm, P = 0.012) compared to NF-PitNET group. Intersphenoid sinus septum showed no differences between the 2 groups.

CONCLUSIONS: Intercarotid distance, DSS, and VCD resulted smaller in acromegalic patients, confirming that patients with GH-secreting PitNETs have a narrower surgical field. A meticulous anatomical preoperative planning and neuronavigation are important to recognize the sphenoid anatomical landmarks in order to reduce the risk of complications, especially in acromegalic patients.

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Anatomical Differences in Sphenoid Sinus During Endoscopic Transsphenoidal Surgery: Comparison Between Nonfunctioning Pituitary Neuroendocrine Tumor (PiTNET) and Growth Hormone-Secreting PiTNET

Abstract

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