Assessment of sellar parameters using computed tomography for a safe endonasal transsphenoidal approach in pituitary surgery.

Purpose: Endoscopic endonasal transsphenoidal surgery (EETS) is a key treatment for pituitary tumours unresponsive to medication, but it carries risks such as internal carotid artery injury and cavernous sinus haemorrhage. This study aims to establish safe surgical boundaries by measuring sellar region parameters on computed tomography angiography (CTA) images to enhance EETS efficacy and minimize complications.

Methods: This study involved 460 adult patients who underwent head and neck CTA scanning at our clinic from August 2023 to April 2024. Measurements taken from CTA images included skull base angle (SBA), Anterior Surgical Angle (ASA), Posterior Surgical Angle (PSA), Anterior Distance 1 (AD1), Anterior Distance 2 (AD2), Posterior Distance 1 (PD1), Posterior Distance 2 (PD2), Safe Window Area (SWA), Depth of the Sella Turcica (DST), Intercarotid Distance (ID), Apex Nasi-Sella Turcica Angle (ANSTA), Sella Anterior Wall Thickness (TSAW) and Sella Floor Wall Thickness (TSFW). Sphenoid sinus types were also assessed, with comparisons made between genders and age groups.

Results: When comparing genders, median values of SBA, ASA, DST and ANSTA were significantly higher in females, whereas AD1, AD2, PD1, PD2, SWA, ID and TSAW were significantly higher in males (p < 0.05). Moreover, correlation analysis revealed a significant positive correlation between age and PSA, PD1-2, ID, TSAW and TSFW.

Conclusion: Pre-operative measurement of sella turcica parameters and sphenoid sinus type by radiologists is crucial for neurosurgeons planning EETS for pituitary lesions, potentially reducing complications through a better understanding of surgical anatomy.