The relationship between the variations of sphenoid sinus and nasal septum

The aim of this article is to discuss the sphenoid sinus variations that could be important for transsphenoidal pituitary surgery planning. 314 computed tomography angiography performed with 64-detector multi-slice scanner of the head and neck region in consecutive patients were studied. Thin slices axial, coronal and sagittal, maximum intensity projection and multiplanar reformatted images were obtained for detailed evaluation. 57 cases had presellar (18.2%), 40 patients had sellar (12.7%), 214 patients (68.2%) had postsellar and 3 patients (1%) had conchal pneumatization. We identified sellar bulging in 249 of 314 cases (79.3%), (43% mild, 36.3% prominent). We detected more than one septum in 107 cases (34.1%). In 4 cases (1.3%) we could not define any septum. Nasal septum was deviated to the right in 129 cases (41.1%), deviated to the left in 140 cases (44.6%) and non-deviated in 45 patients (14.3%). There was statistically significant difference in the mean distances between the deviated main sphenoid septum and the internal carotid arteries on the deviation and opposite sides. Knowing the nasal septal deviation direction does not facilitate to predict the direction of the deviation of the main sphenoid septum. Reporting important anatomical variations routinely in computed tomography and/or magnetic resonance imaging reports in transsphenoidal pituitary surgery candidates may reduce transsphenoidal pituitary surgery complications during surgery.