Surgical aspects of the anatomy of the sphenoidal sinuses and the sella turcica
Kinnman, J.
Journal of Anatomy 124(Pt 3): 541-553
1977
ISSN/ISBN: 0021-8782 PMID: 203568 Document Number: 121648
The anatomy of the sphenoidal sinuses and the sella turcica is studied on the basis of surgical material and autopsy specimens. In 80 acromegalic patients with pneumatization was of the sellar type in 89% (a conchal type of pneumatization was found in 1 patient only). In this series the intersinus septum was situated in the midline in only 42%. Extrasepta were found in 15 sinuses. The intersinus septum, as well as the extrasepta, may have their posterior attachment at the carotid prominence. Posterior ethmoidal cells may form a part of the sella turcica or the trigonum pressellare. The carotid arteries become tortous in older patients and may protrude into the sellar cavity. The optic canal may have a part of its course within the sphenoid sinus. The pituitary gland may increase in size as much as double without altering the bony sella. In the expanding sella the angle between the planum sphenoidale and the anterior wall of the sella becomes more or less acute. The floor of the sella in ordinary lateral views may appear with several contours due to lateral inclination or asymmetric enlargement. Conspicious asymmetry of the sellar floor was seen in 36 cases. Rarefaction or destruction of the dorsum sellae is also common in acromegaly and was seen in 39% of the patients. A postoperative sellar reconstitution was noted in 64%. The new bone formation may be very pronounced, and difficulties may be encountered at re-operations. The relation between the pituitary gland or a pituitary tumor to the diaphragma sellae is important; supradiaphragmatic tumors without sellar extension should not be treated by transsphenoidal operation.