Fonksiyonel hipofiz adenomlarında transsfenoidal rezeksiyon volümünün nazal ve sfenoid sinüs ölçümleriyle değerlendirilmesi
Evaluation of transsphenoidal resection volume in functional pituitary adenomas by nasal and sphenoid sinus measurements
Yazar: EYLEM YAĞMUR ÖZKELEŞ
Danışman: PROF. DR. HAKAN KARABAĞLI
Selçuk Üniversitesi / Tıp Fakültesi / Beyin ve Sinir Cerrahisi Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2023
Konu: Nöroşirürji = Neurosurgery
Dizin: Hipotalamo hipofizeal sistem = Hypothalamo hypophyseal system

Özet:
Objective: In our study, we aimed to reveal the relationship between the tumor resection volume in
transsphenoidal pituitary surgery and the anatomical differences that may be encountered in the nasal
and sphenoid sinus anatomy, to suggest new approaches to this surgical procedure, and to emphasize
the features that need to be taken into consideration.
Material and method: A total of 63 cases who were operated on by two different surgeons due to
functional pituitary adenoma via transsphenoidal route at Selçuk University Faculty of Medicine
Neurosurgery Clinic between 2010 and 2022 were included in the study. Microscopic method was
used in 47 cases and endoscopic method was used in 16 cases. 30 of the patients are women and 33
are men. The average age is 49.5, the minimum age is 17 and the maximum age is 81. The sphenoid
sinus types of these patients were grouped according to the degree of pneumatization. Volume data
was provided using preoperative and early postoperative magnetic resonance images through the
Syngo.via imaging program. Using the Enlil PACS program, the distances between the columella base
and the sphenoid sinus and the angle measurements of this direction with the nasal cavity floor were
obtained from preoperative pituitary magnetic resonance T1 sagittal sequence sections. The
relationship between these parameters was evaluated statistically.
Results: There were 10 (15.9%) people with pathology type PRL+ GH+ adenoma, 17 (27%) people
with gonadotrope adenoma, 13 (20.6%) people with somatotrope adenoma, 11 (17.5%) people with
lactotrope adenoma, 6 (9.5%) individuals with ACTH+ adenomas and 6 (9.5%) individuals with GH+
adenomas. There were 47 (74.6%) whose surgery type was microscopic and 16 (25.4%) who had
endoscopic. While the mean early postoperative resection volume was 4.95±5.36 m3
, the mean late
postoperative resection volume was found to be 4.29±5.32 m3
, and there was no statistically
significant difference between these measurements (p>0.05). In early and late postoperative
measurements, resection volume averages were statistically significantly lower in the invasive
sphenoid sinus type (p<0.05). In invasive and sellar sphenoid sinus types, the first measurement
resection volume average was statistically higher than the other measurements (p<0.05). There was no
statistically significant difference between the mean of early postoperative resection volume and the
mean of late postoperative resection volume (p>0.05). There was no statistically significant difference
in presellar sphenoid sinus type (p>0.05). The average resection volume rate in sellar sphenoid sinus
types was found to be 61.54±18.48, and this measurement was statistically higher than other sphenoid
sinus types (p<0.05). While the average resection volume ratio in the presellar sphenoid sinus type
was 46.07±18.14, the average resection volume ratio in the invasive sphenoid sinus type was found to
be 44.17±24.52, and there was no statistically significant difference between these types (p>0.05).
There was no statistically significant difference between the mean of early postoperative resection
volume and the mean of late postoperative resection volume (p>0.05). As a result, when the effect

sizes were examined, resection volume showed a rapid decrease in microscopic (η2=0.437) and
endoscopic (η2=0.157) measurements, respectively, across surgery types. While the average resection
volume rate in those operated with the microscopic method was 57.79±19.41, the average resection
volume rate in those operated with the endoscopic method was 60.24±21.55, and there was no
statistically significant difference between these surgical types (p>0.05). The distance between the
columella and the sphenoid sinus and preoperative resection volume measurements did not have a
statistically significant effect on the resection volume rate (p>0.05). While resection volume showed a
rapid decrease in gonadotrope (η2=0.327), PRL+ GH+(η2=0.240), GH+(η2=0.238) and somatotroph
(η2=0.118) measurements in pathology types, respectively, no significant intra-group difference was
observed in lactotrope and ACTH+ surgery types.
Conclusion: In pituitary adenomas operated with the transphenoidal approach, different anatomical
markers are used to determine the anatomical corridor until reaching the adenoma. These markers are
a result of the surgical experience and studies achieved to date. In this study, we have conveyed our
clinical experience to the literature by showing that the tumor resection volume is not affected by
some measurements of the sphenoid sinus and nasal cavity. We think that there are still anatomical
differences that may affect the tumor resection volume and that further studies should be continued
with a larger number of patients in different centers.
Keywords: Columella; pituitary adenoma; transsphenoidal approach; sphenoid sinus; nasal cavity;
tumor volume.

Abstract:
Objective: In our study, we aimed to reveal the relationship between the tumor resection volume in
transsphenoidal pituitary surgery and the anatomical differences that may be encountered in the nasal
and sphenoid sinus anatomy, to suggest new approaches to this surgical procedure, and to emphasize
the features that need to be taken into consideration.
Material and method: A total of 63 cases who were operated on by two different surgeons due to
functional pituitary adenoma via transsphenoidal route at Selçuk University Faculty of Medicine
Neurosurgery Clinic between 2010 and 2022 were included in the study. Microscopic method was
used in 47 cases and endoscopic method was used in 16 cases. 30 of the patients are women and 33
are men. The average age is 49.5, the minimum age is 17 and the maximum age is 81. The sphenoid
sinus types of these patients were grouped according to the degree of pneumatization. Volume data
was provided using preoperative and early postoperative magnetic resonance images through the
Syngo.via imaging program. Using the Enlil PACS program, the distances between the columella base
and the sphenoid sinus and the angle measurements of this direction with the nasal cavity floor were
obtained from preoperative pituitary magnetic resonance T1 sagittal sequence sections. The
relationship between these parameters was evaluated statistically.
Results: There were 10 (15.9%) people with pathology type PRL+ GH+ adenoma, 17 (27%) people
with gonadotrope adenoma, 13 (20.6%) people with somatotrope adenoma, 11 (17.5%) people with
lactotrope adenoma, 6 (9.5%) individuals with ACTH+ adenomas and 6 (9.5%) individuals with GH+
adenomas. There were 47 (74.6%) whose surgery type was microscopic and 16 (25.4%) who had
endoscopic. While the mean early postoperative resection volume was 4.95±5.36 m3
, the mean late
postoperative resection volume was found to be 4.29±5.32 m3
, and there was no statistically
significant difference between these measurements (p>0.05). In early and late postoperative
measurements, resection volume averages were statistically significantly lower in the invasive
sphenoid sinus type (p<0.05). In invasive and sellar sphenoid sinus types, the first measurement
resection volume average was statistically higher than the other measurements (p<0.05). There was no
statistically significant difference between the mean of early postoperative resection volume and the
mean of late postoperative resection volume (p>0.05). There was no statistically significant difference
in presellar sphenoid sinus type (p>0.05). The average resection volume rate in sellar sphenoid sinus
types was found to be 61.54±18.48, and this measurement was statistically higher than other sphenoid
sinus types (p<0.05). While the average resection volume ratio in the presellar sphenoid sinus type
was 46.07±18.14, the average resection volume ratio in the invasive sphenoid sinus type was found to
be 44.17±24.52, and there was no statistically significant difference between these types (p>0.05).
There was no statistically significant difference between the mean of early postoperative resection
volume and the mean of late postoperative resection volume (p>0.05). As a result, when the effect
73
sizes were examined, resection volume showed a rapid decrease in microscopic (η2=0.437) and
endoscopic (η2=0.157) measurements, respectively, across surgery types. While the average resection
volume rate in those operated with the microscopic method was 57.79±19.41, the average resection
volume rate in those operated with the endoscopic method was 60.24±21.55, and there was no
statistically significant difference between these surgical types (p>0.05). The distance between the
columella and the sphenoid sinus and preoperative resection volume measurements did not have a
statistically significant effect on the resection volume rate (p>0.05). While resection volume showed a
rapid decrease in gonadotrope (η2=0.327), PRL+ GH+(η2=0.240), GH+(η2=0.238) and somatotroph
(η2=0.118) measurements in pathology types, respectively, no significant intra-group difference was
observed in lactotrope and ACTH+ surgery types.
Conclusion: In pituitary adenomas operated with the transphenoidal approach, different anatomical
markers are used to determine the anatomical corridor until reaching the adenoma. These markers are
a result of the surgical experience and studies achieved to date. In this study, we have conveyed our
clinical experience to the literature by showing that the tumor resection volume is not affected by
some measurements of the sphenoid sinus and nasal cavity. We think that there are still anatomical
differences that may affect the tumor resection volume and that further studies should be continued
with a larger number of patients in different centers.
Keywords: Columella; pituitary adenoma; transsphenoidal approach; sphenoid sinus; nasal cavity;
tumor volum