Download PDF
J Neurol Surg B Skull Base 2015; 76(04): 316-322
DOI: 10.1055/s-0035-1549002
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Planum-Clival Angle Classification: A Novel Preoperative Evaluation for Sellar/Parasellar Surgery

Fahad Alkherayf
1   Division of Neurosurgery, Department of Surgery, University of Ottawa, The Ottawa Hospital (Civic Campus), Ontario, Canada
2   The Ottawa Hospital Research Institute (OHRI), Ontario, Canada
,
Idara Edem
1   Division of Neurosurgery, Department of Surgery, University of Ottawa, The Ottawa Hospital (Civic Campus), Ontario, Canada
,
Jean-Marc Ouattara
1   Division of Neurosurgery, Department of Surgery, University of Ottawa, The Ottawa Hospital (Civic Campus), Ontario, Canada
,
Andre Lamothe
3   Department of Otolaryngology, Head and Neck Surgery, University of Ottawa, The Ottawa Hospital (Civic Campus), Ontario, Canada
,
Charles Agbi
1   Division of Neurosurgery, Department of Surgery, University of Ottawa, The Ottawa Hospital (Civic Campus), Ontario, Canada
› Author Affiliations
Further Information

Publication History

25 July 2014

08 January 2015

Publication Date:
27 April 2015 (online)

    Permissions and Reprints

Abstract

Objective Endonasal approaches are increasingly used to treat sellar pathologies, leading to increased interest in achieving maximal safe resection. We propose a tool—the planum-clival angle (PCA)—and explore its surgical implications for sellar pathology resections.

Design Retrospective analysis.

Participants Consecutive patients with pituitary lesions between 2003 and 2013.

Outcome Measures The PCA and suprasellar extension ratios; head position and extent of surgical resection.

Results We enrolled 89 patients (ages 21–88 years). There were 15 type A patients (17%), 13 with suprasellar extension (89%) and ratios between 0.12 and 0.70. There were 61 type B patients (70%), 49 with suprasellar extension (81%) and ratios from 0.09 to 0.66. Finally, there were 13 type C patients (13%), 10 with suprasellar extension (73%) and ratios from 0.21 to 0.76. Type B was treated with a sphenoidectomy and neutral head positioning, type A with 10 to 20 degrees of flexion and an additional posterior ethmoidectomy with or without posterior planum resection, and type C with 10 to 20 degrees of extension and an additional superior clival resection.

Conclusions Sellar anatomy and PCA influence the growth patterns of sellar lesions. Thus PCA should allow for better surgical planning and thereby improve surgical efficacy.

Keywords

sella turcica - pituitary adenoma - transsphenoidal surgery - planum sphenoidale - clivus
 

  • References

  • 1 Renn WH, Rhoton Jr AL. Microsurgical anatomy of the sellar region. J Neurosurg 1975; 43 (3) 288-298
    CrossrefPubMedGoogle Scholar
  • 2 Daly AF, Rixhon M, Adam C, Dempegioti A, Tichomirowa MA, Beckers A. High prevalence of pituitary adenomas: a cross-sectional study in the province of Liege, Belgium. J Clin Endocrinol Metab 2006; 91 (12) 4769-4775
    CrossrefPubMedGoogle Scholar
  • 3 Freda PU, Post KD. Differential diagnosis of sellar masses. Endocrinol Metab Clin North Am 1999; 28 (1) 81-117, vi
    CrossrefPubMedGoogle Scholar
  • 4 Schloffer H. Erfolgreiche operation eines hypophysentumors auf nasalem Wege. Wien Klin Wochenschr 1907; 20: 621-624
    PubMedGoogle Scholar
  • 5 Elster AD. Imaging of the sella: anatomy and pathology. Semin Ultrasound CT MR 1993; 14 (3) 182-194
    CrossrefPubMedGoogle Scholar
  • 6 Rhoton Jr AL, Harris FS, Renn WH. Microsurgical anatomy of the sellar region and cavernous sinus. Clin Neurosurg 1977; 24: 54-85
    CrossrefPubMedGoogle Scholar
  • 7 Snyderman CH, Pant H, Carrau RL, Prevedello D, Gardner P, Kassam AB. What are the limits of endoscopic sinus surgery?: the expanded endonasal approach to the skull base. Keio J Med 2009; 58 (3) 152-160
    CrossrefPubMedGoogle Scholar
  • 8 Ciric I, Ragin A, Baumgartner C, Pierce D. Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience. Neurosurgery 1997; 40 (2) 225-236; discussion 236–237
    CrossrefPubMedGoogle Scholar
  • 9 Campero A, Socolovsky M, Torino R, Martins C, Yasuda A, Rhoton Jr AL. Anatomical landmarks for positioning the head in preparation for the transsphenoidal approach: the spheno-sellar point. Br J Neurosurg 2009; 23 (3) 282-286
    CrossrefPubMedGoogle Scholar
  • 10 Zagga AD, Ahmed H, Tadros AA, Saidu SA. Description of the normal variants of the anatomical shapes of the sella turcica using plain radiographs: experience from Sokoto, Northwestern Nigeria. Ann Afr Med 2008; 7 (2) 77-81
    CrossrefPubMedGoogle Scholar
  • 11 Bruneton JN, Drouillard JP, Sabatier JC, Elie GP, Tavernier JF. Normal variants of the sella turcica. Radiology 1979; 131 (1) 99-104
    CrossrefPubMedGoogle Scholar
  • 12 Axelsson S, Storhaug K, Kjaer I. Post-natal size and morphology of the sella turcica. Longitudinal cephalometric standards for Norwegians between 6 and 21 years of age. Eur J Orthod 2004; 26 (6) 597-604
    CrossrefPubMedGoogle Scholar
  • 13 Alkofide EA. The shape and size of the sella turcica in skeletal Class I, Class II, and Class III Saudi subjects. Eur J Orthod 2007; 29 (5) 457-463
    CrossrefPubMedGoogle Scholar
  • 14 Hamberger CA, Hammer G, Norlen G, Sjogren B. Transantrosphenoidal hypophysectomy. Arch Otolaryngol 1961; 74: 2-8
    CrossrefPubMedGoogle Scholar
  • 15 Lazaridis N, Natsis K, Koebke J, Themelis C. Nasal, sellar, and sphenoid sinus measurements in relation to pituitary surgery. Clin Anat 2010; 23 (6) 629-636
    CrossrefPubMedGoogle Scholar
  • 16 Ramakrishnan VR, Suh JD, Lee JY, O'Malley Jr BW, Grady MS, Palmer JN. Sphenoid sinus anatomy and suprasellar extension of pituitary tumors. J Neurosurg 2013; 119 (3) 669-674
    CrossrefPubMedGoogle Scholar
  • 17 Zada G, Lin N, Laws Jr ER. Patterns of extrasellar extension in growth hormone-secreting and nonfunctional pituitary macroadenomas. Neurosurg Focus 2010; 29 (4) E4
    PubMedGoogle Scholar