CT-Based Evaluation of Sphenoid Sinus Type and Sella Turcica-Related Quantitative Parameters for Endoscopic Endonasal Transsphenoidal Approach Planning in Pediatric Patients.

Background: To evaluate sphenoid sinus (SS) types and sella turcica (ST)-related quantitative parameters on contrast-enhanced computed tomography (CECT) images according to age and sex in pediatric patients, and to assess their relevance to endoscopic endonasal transsphenoidal approach (EETA) planning. Methods: This retrospective study included 254 patients younger than 18 years without sellar or SS pathology. Patients were categorized according to age and sex. The following parameters were assessed on CECT images: SS type, skull base angle, anterior surgical angle (ASA), posterior surgical angle (PSA), anterior distances (AD1-2), posterior distances (PD1-2), sella turcica depth (DST), intercarotid distance (ID), safe window area (SWA), apex nasi-sella turcica angle (ANSTA), thickness of the sella turcica anterior wall (TSAW), and thickness of the sella turcica floor wall (TSFW). Results: The mean age was 9.72 ± 5.03 years. Although the conchal SS type was most frequent among patients aged 0-6 years, the sellar and postsellar types increased with advancing age. With advancing age, ASA, PSA, AD1-2, PD1-2, DST, ID, and SWA increased, whereas TSAW decreased. In unadjusted comparisons, all evaluated quantitative parameters differed significantly among SS types (p < 0.05). SWA showed significant positive correlations with ASA, PSA, AD1-2, PD1-2, and ANSTA, and a significant negative correlation with TSAW (p < 0.001). Conclusions: Pediatric SS and ST anatomy show substantial age-related changes. Assessment of CECT-based quantitative parameters may help define the sellar corridor, estimate the available working area, and support EETA planning.