Radiological features for the approach in trans-sphenoidal pituitary surgery.
BACKGROUND
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.
Department of Otorhinolaryngology, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK. vmtwigg@googlemail.com.
Victoria
V
Twigg
Department of Otorhinolaryngology, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK.
Simon D
SD
Carr
Department of Otorhinolaryngology, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK.
Ramkishan
R
Balakumar
Department of Neurosurgery, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK.|Department of Neurosurgery, Sheffield Children's Hospital, Western Bank, Sheffield, S10 2TH, UK.
Saurabh
S
Sinha
Department of Otorhinolaryngology, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK.
Showkat
S
Mirza
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D007016:Hypophysectomy / Q000379:methods; D009682:Magnetic Resonance Spectroscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009300:Nasal Septum / Q000000981:diagnostic imaging / Q000601:surgery; D010902:Pituitary Gland / Q000000981:diagnostic imaging* / Q000601:surgery*; D013101:Sphenoid Sinus / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods; D014420:Turbinates / Q000000981:diagnostic imaging / Q000601:surgery; D055815:Young Adult
Anatomic landmarks; Checklist; Hypophysectomy; Pituitary gland; Pituitary surgery; Sphenoid sinus