Sellar region related to the transsphenoidal endoscopic approach of pituitary surgery

Transsphenoidal endoscopic approach gives significant advantages in the surgery of pituitary adenomas. A sound knowledge of the anatomy is essential for the surgeons to perform the procedure in a safe and efficient way. This study aims to provide a better understanding of the complex anatomical structures involved in the transsphenoidal approach and to increase familiarity with the endoscopic views and associated skills.

Computed tomographic angiography images from 122 individuals were used for measurements between landmark structures that are relevant to these surgeries. The parameters including the size, shape, and available angles were measured.

The angle between 2 lines that are from the sphenoidal rostrum to the middle point of tuberculum sellae and to the tangential point of a tangent which is through the center of sphenoidal rostrum to the pituitary fossa (AR) was 30.62 ± 4.70 degrees; the angle between 2 lines that are from the unilateral sphenoidal rostrum to the bilateral nearest point of the 2 internal carotid arteries within the area of sellar region (AI) was 39.06 ± 9.82 degrees; the anteroposterior diameter of the pituitary fossa (SP) was 11.07 ± 1.36 mm; the vertical diameter of the pituitary fossa (BH) was 7.20 ± 1.46 mm; the distance from the middle point of tuberculum sellae to the lowest point of the pituitary (SB) was 9.59 ± 1.37 mm; the angle between line SB and the horizontal plane (ASB) was 49.29 ± 7.51 mm; the width of tuberculum sellae was (SD) 10.16 ± 1.47 mm; the width of the intermediate part of the pituitary fossa was (BD) 12.09 ± 2.01 mm; the width of the posterior wall of the pituitary fossa (PD) was 12.84 ± 1.57 mm; and the ply of the bone of the front (PB) and bottom (PA) of pituitary fossa were 0.75 ± 0.22 mm and 0.91 ± 0.26 mm, respectively.

These measurements can help to understand the complicated anatomical structures around the pituitary fossae and can contribute to ensure the efficiency and success of the surgery as well.