Abdülkadir İMRE, Ercan PINAR, Nurullah YÜCEER, Murat SONGU, Yüksel OLGUN, İbrahim ALADAĞ

Onodi hücresi transsfenoidal hipofiz cerrahisinde sella ekspojurunu kısıtlar mı?

Amaç: Bu çalışmada, endonazal endoskopik transsfenoidal hipofiz cerrahisinde EETHC Onodi hücresi varlığının sella ekspojuru ile olan ilişkisi araştırıldı.Hastalar ve Yöntemler: Katip Çelebi Üniversitesi Atatürk Eğitim ve Araştırma Hastanesi’nde Şubat 2011 ve Mart 2014 tarihleri arasında Nöroşirürji ve Kulak Burun Boğaz kliniklerinde hipofiz adenomu nedeniyle ortaklaşa EETHC ile ameliyat edilen 42 hasta retrospektif olarak incelendi. Ameliyat öncesi paranazal sinüs tomografileri ve ameliyat sırası bulguları, Onodi hücresi varlığı yönünden değerlendirildi. Ameliyat esnasında Onodi hücresinin yerleşim yeri ve sella ekspojuru ilişkisi değerlendirildi.Bulgular: Onodi hücre insidansı %19.0 olarak saptandı. Ameliyat öncesi paranazal sinüs bilgisayarlı tomografisinde; 42 hastanın sekizinde Onodi hücresi gözlendi. Onodi hücresi beş hastada tek taraflı, üç hastada iki taraflı idi. Ameliyat sırası bulgular tomografi bulguları ile ilişkili idi. Yedi hastada Onodi hücresi sella ekspojurunu kısıtladığı için Onodi hücresi inferior-medial duvardan açılarak sfenoid sinüs boşluğu ile birleştirildi ve tam sella ekspojuru sağlandı. Kalan bir hastada ise Onodi hücresi tek taraflı ve superolateral yerleşimli küçük bir hücre idi. Bu hücre sella ekspojurunu kısıtlamadığı için çıkarılmadı.Sonuç: Onodi hücresi transsfenoidal cerrahide sella ekspojurunu kısıtlayabilmektedir. Geniş bir sella ekspojurunun sağlanabilmesi için Onodi hücresinin uzaklaştırılıp sfenoid sinüs boşluğu ile birleştirilmesi gereklidir

Anahtar Kelimeler:

Onodi hücresi, sellar tümör, transsfenoidal hipofiz cerrahisi

Does Onodi cell limit the exposure of sella during transsphenoidal pituitary surgery?

Objectives: This study aims to evaluate the association between the presence of Onodi cell and sella exposure during endonasal endoscopic transsphenoidal pituitary surgery EETPS . Patients and Methods: Forty-two patients who underwent EETPS for a pituitary adenoma with the collaboration of Neurosurgery and Otorhinolaryngology Departments at Katip Çelebi University Atatürk Training and Research Hospital between February 2011 and March 2014 were retrospectively analyzed. Preoperative paranasal sinus tomography and intraoperative findings were evaluated for the presence of Onodi cells. The location of the Onodi cell and its relation with sella exposure during surgery were also assessed. Results: The incidence of Onodi cell was 19%. The Onodi cells were observed in eight of 42 patients on preoperative paranasal sinus computed tomography. The Onodi cells were unilateral in five patients and bilateral in three. Intraoperative findings were correlated with tomographic findings. In seven patients, Onodi cells limited the exposure of sellar floor and the inferior-medial wall of these cells were removed and connected with the sphenoid sinus and the entire sellar floor was exposed. In the remaining one patient, the Onodi cell was smaller and located superolaterally. This cell was not removed, as it did not limited the sellar exposure. Conclusion: The Onodi cell may limit the sella exposure during transsphenoidal surgery. Onodi cell should be removed and connected with the sphenoid sinus cavity for the entire sellar floor exposure.

Keywords:

Onodi cell, sellar tumor, transsphenoidal pituitary surgery,

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