Endonasal Operative Corridor Expansion by Sphenoidal Pneumosinus Dilatans in Tuberculum Sellae Meningiomas

Background A retrospective cohort study of patients with tuberculum sellae meningioma (TSM)–associated sphenoidal pneumosinus dilatans (PSD) over a recent epoch was evaluated using a propensity-matched morphometric analysis. Methods A total of 38 patients with TSM and sphenoidal PSD were identified and matched by age and sex to 32 patients without tumors (controls). Results Overall, no significant difference between test and control groups was noted in sphenoid sinus size or other parameters; however, significantly greater mean distances from the posterior margin of the planum sphenoidale to the diaphragma sella (0.76 ± 0.23 vs. 1.03 ± 0.27, respectively; P = 0.0001) and angle between the planum sphenoidale to anterior face of sella turcica (113.41 ± 10.58 vs. 123.21 ± 12.55, respectively; P = 0.001) were seen in patients with TSM and PSD, suggestive of a selective expansion of the tuberculum sellae region. TSM/sphenoid sinus morphologies were divided into 3 types (A, B, and C) based on the extent of tumor and sinus morphology. There was progressive increase in tumor volume and anteroposterior sinus diameter from sphenoidal PSD types A–C, which influenced selection of surgical approach. Conclusions This study suggests that TSM-associated sphenoidal PSD leads to more selective splaying of the tuberculum sellae region rather than cumulative increase in sinus volume. This may lead to operative corridor expansion for endonasal access to TSM associated with sphenoidal PSD. A radiologic classification scheme for sphenoidal PSD associated with TSM is suggested that may aid surgical decision-making.