Intrasphenoid septations inserted into the internal carotid arteries: a frequent and risky relationship in transsphenoidal surgeries

Publication date: Available online 22 April 2016
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Clauder Oliveira Ramalho, Horacio Armando Marenco, Francisco de Assis Vaz Guimarães Filho, Marcos Devanir Silva da Costa, Bruno Fernandes de Oliveira Santos, Rodrigo de Paula Santos, Samuel Tau Zymberg
IntroductionWhen an expanded endonasal transsphenoidal surgical approach is performed, intrasphenoid septations must be completely resected. If these structures are close to the internal carotid artery (ICA), then their manipulation might cause vascular injury.ObjectiveThe objective of this study is to describe the frequency of intrasphenoid septations in the internal carotid artery protuberance (ICAp).MethodsComputed tomography (CT) scans of 421 patients were analysed. Intrasphenoid septations (classified as intersphenoid or accessory) and their relationship to the ICAp were described. Additionally, a sphenoid sinus classification was performed based on their degree of pneumatisation to determine whether a difference exists in the frequency of intrasphenoid septations inserted into ICAp with regard to sinus type.ResultsPatient mean age was 39±21.4 years. Overall, 219 patients (52%) had septations in the ICAp; 359 patients (85.3%) had intersphenoid septations; out of them, 135 (37.6%) had septations in the ICAp. This frequency was higher among patients with sphenoid sinus type 4 or 5 (44.7% and 43.5%, respectively). Accessory septations were found in 255 patients (60.6%); 140 of these septations (54.9%) were in the ICAp. Among 351 patients with types 3, 4 or 5 sphenoid sinuses (i.e., only well-pneumatised sphenoid sinuses), 219 (62.4%) had septations in the ICAp. These frequencies are higher than those reported in most previous studies. The frequency of intrasphenoid septations in the ICAp found is considerable. It is higher among patients with more pneumatised sinuses.ConclusionThis finding justifies an appropriate pre-operative study, and careful attention must be paid during transsphenoidal surgery.



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