Anatomical Feature of Nasal Cavity for Endoscopic Endonasal Skull Base Surgery in Patients With GHoma.

BACKGROUND

Endoscopic endonasal skull base surgery (EESS) is widely performed for pituitary tumors. In growth hormone-secreting adenomas (GHomas), the procedure is technically more demanding than for other pituitary neuroendocrine tumor (PitNET) subtypes due to restricted instrument maneuverability. Few studies have evaluated the influence of nasal cavity morphology on this difficulty.

OBJECTIVE

To identify anatomical factors contributing to the technical challenges of EESS for GHomas by comparing nasal cavity structures between GHoma and non-GHoma PitNET patients.

STUDY

DESIGN

Retrospective chart review.

SETTING

Tertiary referral center with a collaborative skull base team of neurosurgery and otolaryngology.

METHODS

Computed tomography (CT) images of 28 GHoma and 104 non-GHoma PitNET patients who underwent EESS between August 2018 and April 2024 were analyzed. Measurements included inter-vidian canal distance, nasolacrimal duct opening width, inferior turbinate width, piriform aperture width, sphenopalatine foramen width, inter-carotid artery distance, skull base-to-hard palate distance, anterior nasal spine-to-clivus distance, and anterior sphenoid wall-to-clivus distance. Comparisons were performed using Student's t-test.

RESULTS

GHoma patients showed significantly greater nasolacrimal duct opening width, piriform aperture width, and anterior nasal spine-to-clivus distance (P < .05). Vertical-to-horizontal ratios did not differ significantly. However, the inter-carotid artery distance and the ratios of inter-carotid distances to the anterior nasal spine-to-clivus distance were significantly smaller in GHomas.

CONCLUSION

GHoma patients possess generally larger sinonasal dimensions, yet a narrower paraclival inter-carotid space limit surgical maneuverability. These CT-based anatomical differences may have potential implications for preoperative anatomical assessment in patients with GHomas.

LEVEL OF EVIDENCE: IV.