Variability in sphenoid sinus pneumatization and its impact upon reduction of complications following sellar region surgeries

BackgroundThe rapid evolution of transsphenoidal endoscopic surgical intervention and surgeries of skull base and sellar regions is accompanied by multiple complications.ObjectiveTo determine different types of extension of sphenoid sinus pneumatization detected by CT and MRI and their impact upon different approaches and complications of sellar region surgeries.Subjects and methodsThe pre-operative CT and MRI images of 182 patients with surgical intervention for peri-sellar region pathologies were retrospectively evaluated for patterns of sphenoid pneumatization. Post surgical complications were recorded and analyzed.ResultsThe overall rate of complications was 88 affecting 62 patients (34%), and 120 patients (66%) were free of complications. Different types of pneumatization were detected on CT and MRI images, conchal in 3 cases (1.6%), presellar 23 cases (12.6%) and 156 cases (85.7%) showing sellar pneumatization. Sellar pattern was reclassified into 6 types. Single inter sphenoid septum was seen in 109 patients, accessory septum was found in 13 patients and 10 patients have multiple sphenoid septation. 24 patients (13.2%) show absent septum.ConclusionPre-intervention assessment of sphenoid sinus pneumatization is mandatory in approaching the sella and skull base structures either via the nose or open skull base surgery to avoid injury of the nearby structures and reduce the possibility of CSF leakage.