Abstract:
INTRODUCTION:In order to perform trans-sphenoidal endoscopic pituitary surgery safely and efficiently it is important to identify anatomical and pituitary disease features on the pre-operative CT and MRI scans; thereby minimising the risk to surrounding structures and optimising outcomes. We aim to create a checklist to streamline pre-operative planning. METHODS:We retrospectively reviewed pre-operative CT and MRI scans of 100 adults undergoing trans-sphenoidal endoscopic pituitary surgery. RESULTS:Radiological findings and their incidence included deviated nasal septum (62%), concha bullosa (32%), bony dehiscence of the carotid arteries (18%), sphenoid septation overlying the internal carotid artery (24% at the sella) and low lying CSF (32%). The mean distance of the sphenoid ostium to the skull base was 10 mm (range 2.7-17.6 mm). We also describe the 'teddy bear' sign which when present on an axial CT indicates the carotid arteries will be identifiable intra-operatively. CONCLUSIONS:There are significant variations in the anatomical and pituitary disease features between patients. We describe a number of features on pre-operative scans and have devised a checklist including a new 'teddy bear' sign to aid the surgeon in the anatomical assessment of patients undergoing trans-sphenoidal pituitary surgery.
journal_name
Pituitaryjournal_title
Pituitaryauthors
Twigg V,Carr SD,Balakumar R,Sinha S,Mirza Sdoi
10.1007/s11102-017-0787-9subject
Has Abstractpub_date
2017-08-01 00:00:00pages
395-402issue
4eissn
1386-341Xissn
1573-7403pii
10.1007/s11102-017-0787-9journal_volume
20pub_type
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