Article
Exposure in endoscopic endonasal transsphenoidal approaches: is middle turbinectomy necessary? An anatomical study
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Authors
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Boris Krischek
- Klinik für Allgemeine Neurochirurgie, Universitätsklinikum Köln; Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Canada
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Francesco Doglietto
- Istituto di Neurochirurgia, Universitta Cattolica del Sacro Cuore, Roma, Italia
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Jimmy Qiu
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada; Division of Anatomy, University of Toronto, Toronto, Canada
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Anne Agur
- Division of Anatomy, University of Toronto, Toronto, Canada
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Gelareh Zadeh
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Canada
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Fred Gentili
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Canada
| Published: | May 21, 2013 |
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Outline
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Objective: The necessity of middle turbinectomy (MT) in endoscopic endonasal transsphenoidal surgery is a highly debated issue. There is a wide variability in clinical practice and no definitive conclusions can be drawn from current clinical studies. We use a software program that allows for the quantification and comparison of different surgical approaches in the anatomy laboratory. In this study we applied this innovative method to answer this specific question.
Method: We acquired CT scans using neuronavigational parameters in ten cadaveric specimen. The images were imported into a neuronavigational system (Guided Therapeutics X eyes™). The system is coupled with a software analysis program that allows quantification of the exposed surface in square centimeters and the volume of the surgical corridor in cubic centimeters. Simulating a binostril approach we determined the area of exposure of the sellar and parasellar region and the volume of the surgical corridor for each nostril before and after an endoscopically performed middle turbinectomy.
Results: The software program projected the surgical corridor on CT-based reconstructions, showing its boundaries including the pterygoid and posterior ethmoids. The area of exposure at the level of the posterior wall of the sphenoid sinus after middle turbinectomy through the left nostril was increased by 39.5% and the gain in volume of the corridor was 8.1%. For the right nostril it was 18.3% and 6.4%, respectively.
Conclusions: Middle turbinectomy significantly increases the surgical exposure to the parasellar area and the overall volume of the surgical corridor in endoscopic endonasal transsphenoidal surgery. Thus, it may be advisable when the pathology extends to the parasellar area and when a wide surgical corridor is needed to include MT in the surgical approach. In addition, calculation of the surgical corridor on preoperatively acquired CT imaging may aid the surgeon in surgical planning and deciding the necessity of a middle turbinectomy.
