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El desarrollo craneofacial es un proceso complejo con diversos factores involucrados. Cuando las maloclusiones son de origen esqueletal pueden generar una relación ortognática (clase I), retrognática (clase II) o prognática (clase III) de la mandíbula respecto de la maxila. Esta configuración está estrechamente relacionada con la base del cráneo donde la silla turca ha sido estudiada con este fin debido a su origen ectomesenquimático (Dasgupta et al., 2018) y sus relaciones anatómicas. Diversos estudios se han realizado para dilucidar esta relación y este trabajo busca aportar a la discusión comparando las características de la silla turca entre las maloclusiones esqueletales a través de telerradiografías laterales. El estudio se realizó mediante 52 placas radiográficas de individuos de entre 18 a 24 años con igual número de sujetos masculinos y femeninos, 15 de clase I, 7 de clase II y 30 de clase III. Se realizó la medición digital del área radiográfica de la silla turca y se clasificó morfológicamente mediante las categorías de Axelsson et al. (2004). Se utilizó coeficiente de correlación intraclase con un 95 % de confianza arrojando un valor de 0,88 para el área de la silla turca, 0,89 para el ángulo ANB y de 0,70 para el valor Wits demostrando una excelente fiabilidad del observador. Con un 95 % de confianza la prueba exacta de Fisher evidenció una asociación significativa (p = 0,029) entre las variaciones morfológicas de la ST y la clase esqueletal siendo más frecuentes en clase III. La prueba H de Kruskal Wallis no arrojó diferencias significativas (p=0,550) en las medianas del área selar entre las clases esqueletales. Las variaciones morfológicas parecen ser más relevantes que las variaciones anatómicas en esta asociación. Se requieren nuevos estudios en población chilena con un mayor número de casos.

SUMMARY: Craniofacial development is a complex process with several factors involved. When malocclusions have a skeletal origin, they can generate an orthognathic (class I), retrognathic (class II) or prognathic (class III) relationship of the mandibular bone respect to the maxilla. This configuration is closely related to the base of the skull where the sella turcica has been studied for this purpose due to its ectomesenchymal origin (Dasgupta et al., 2018) and its anatomical relationships. Several studies have been conducted to elucidate this relationship and this work seeks to contribute to the discussion by comparing the characteristics of the sella turcica among skeletal malocclusions through lateral teleradiographies. The study was conducted using 52 radiographic plates of individuals between 18 and 24 years old with an equal number of male and female subjects, 15 class I, 7 class II and 30 class III. The radiographic area of the sella turcica was digitally measured and morphologically classified using the categories of Axelsson et al. (2004). An intraclass correlation coefficient was obtained with 95 % confidence, yielding a value of 0.88 for the sella turcica area, 0.89 for the ANB angle and 0.70 for the Wits value, demonstrating excellent observer reliability. With 95 % confidence, Fisher's exact test showed a significant association (p = 0.029) between the morphological variations of the ST and the skeletal class, being more frequent in class III. The Kruskal Wallis H test did not show significant differences (p=0.550) in median sellar area between skeletal classes. Morphological variations seem to be more relevant than anatomical variations in this association. New studies are required in the Chilean population with a greater number of cases.

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OBJECTIVE: This study aimed to investigate the limitations, barriers, and complications in the early transition from the microscopic transsphenoidal approach (MTA) to the endonasal endoscopic approach (EEA) to the skull base in our institution. METHODS: Technical challenges, as well as clinical features and complications, were compared between MTA, EEA, and mixed cases during the early surgical curve. RESULTS: The period from the early learning curve was 1 year until the EEA protocol was used routinely. A total of 34 patients registered a resection using a transsphenoidal approach. Eighteen patients underwent EEA, 11 underwent MTA, and five underwent a mixed endonasal and microscopic approach. Non-significant differences were found in endocrine outcomes between the three groups. Patients with unchanged or improved visual function were higher in the EEA group (p = 0.147). Non-significant differences were found in terms of the extent of resection (EOR) between groups (p = 0.369). Only 1 (2.9%) patient in the whole series developed a post-operative CSF leaking that resolved with medical management, belonging to the EEA group (5.5%). CONCLUSIONS: The early phase of the learning curve did not affect our series significantly in terms of the EOR, endocrine status, and visual outcomes.

OBJETIVO: Investigar las limitaciones, las barreras y las complicaciones en la transición del abordaje transesfenoidal microscópico (ATM) al abordaje endonasal endoscópico (AEE) para la base del cráneo en nuestra institución. MÉTODO: Se compararon las características clínicas y las complicaciones entre ATM, AEE y casos mixtos durante la curva quirúrgica temprana. RESULTADOS: El periodo desde la curva de aprendizaje inicial fue de 1 año hasta que se utilizó el protocolo AEE de forma sistemática. Un total de 34 pacientes tuvieron una resección por vía transesfenoidal. A 18 pacientes se les realizó AEE, a 11 ATM y a 5 abordaje mixto endonasal y microscópico. Se encontraron diferencias no significativas en los resultados endocrinos entre los tres grupos. Los pacientes con función visual sin cambios o mejorada fueron más en el grupo AEE (p = 0.147). No se encontraron diferencias significativas respecto a la extensión de la resección (p = 0.369). Solo 1 (2.9%) paciente desarrolló una fístula de líquido cefalorraquídeo que se resolvió con manejo médico, perteneciente al grupo AEE (5.5%). CONCLUSIONES: La fase inicial de la curva de aprendizaje no afectó significativamente a nuestra serie en términos de extensión de la resección, estado endocrino y resultados visuales.

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BACKGROUND: The sphenoid bone is an irregular, unpaired, symmetrical bone located in the middle of the anterior skull and is involved in craniofacial growth and development. Since the morphology of Sella turcica (ST) is associated with different craniofacial patterns, this study aimed to investigate if there is a correlation between ST morphology on the one hand and sagittal craniofacial patterns on the other hand. METHODS: This study was conducted with a convenience sample that included Brazilian individuals undergoing orthodontic treatment. Lateral cephalograms were used to evaluate the calcification pattern and morphology of ST, as well as skeletal class by analyzing the ANB angle. Pearson's chi-square test with Bonferroni post-hoc test was performed to evaluate the association between ST calcification pattern and morphology, and anteroposterior skeletal malocclusion. The established significance level was 0.05. RESULTS: The study collective was comprised of 305 orthodontic patients (178 (58.4 %) female, 127 (41.6 %) male), who had a mean age of 23.2 (±10.6) years. 131 participants (42.9 %) presented skeletal class I, 142 (46.6%) skeletal Class II, and 32 (10.5%) had a skeletal class III. The degree of prognathism of the mandible showed a homogenous distribution within the study collective (91 (29.9 %) orthognathic, 100 (32.9 %) retrognathic, 113 (37.2 %) prognathic mandible). Concerning the maxilla, 92 (30.2%) individuals presented an orthognathic upper jaw, whereas 60 (19.7%) showed maxillary retrognathism and 153 (50.2%) maxillary prognathism. Compared to patients with skeletal class I, skeletal class III individuals presented significantly more hypertrophic posterior clinoid process (p<0.007) and pyramidal shape of the dorsum of the ST (p<0.038). CONCLUSIONS: Our results suggest that the hypertrophic posterior clinoid process and pyramidal shape of the ST dorsum are more prevalent in individuals with skeletal class III malocclusion.

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Intracranial xanthogranulomas (XGs) have been found at various sites, but xanthogranuloma of the sellar region is extremely rare. We report about a case of sellar XG in a 34-year-old female. Magnetic resonance imaging showed a solid-cystic mass located at the sella turcica. The cystic component was hyperintense on the T1-weighted image (WI) and T2WI. The solid component was hyperintense on T1WI and hypointense on T2WI. There was peripheral enhancement after gadolinium administration. The diagnosis of cystic macroadenoma was considered before surgery. Final diagnosis of XG was confirmed by histopathological examination after surgical resection. Gross total resection of the lesion was achieved using the microscope through endoscopic endonasal transsphenoidal approach. The patient had a good outcome and no symptom of diabetes insipidus, hormonal evaluation did not show any alterations compatible with hypopituitarism and prolactin levels were normal XG should receive diagnostic consideration for the sellar mass lesions with cystic components hyperintense on T1WI and T2WI, solid components hyperintense on T1WI and hypointense on T2WI, and CT without evidence of calcifications. It is important to consider the possibility of XG when pertinent, as it facilitates a proper surgical approach strategy.

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OBJECTIVE: This study aimed to explore the relationship between skeletal patterns and the frequency of sella turcica bridging in a sample of young Turkish adults in order to provide a better understanding of the relationship between craniofacial morphology and sella turcica abnormalities. METHODS: A total of 90 individuals aged between 18 and 25 years were examined in this study. The individuals were classified according to their skeletal pattern, specifically Class I, Class II, and Class III. Each group consisted of 15 males and 15 females. The length, depth, and anteroposterior diameter of sella turcica were calculated. The shape and bridging of sella turcica were estimated using lateral cephalometric images. All data were correlated and statistically analyzed according to skeletal patterns, genders, and age. RESULTS: The mean length, depth, and anteroposterior diameter of sella turcica were 7.02±2.13, 7.56±1.38, and 10.54±1.3 mm in Classes I-III, respectively. There was no significant difference between the dimensions of sella turcica according to gender and age (p˃0.05). The length of sella turcica was larger in Class III, and the depth of sella turcica was larger in Class II individuals (p<0.05). A total of 44.4% of the individuals had normal sella turcica, while the remaining 56.6% had other types of sella turcica. It was determined that 31.1% of the individuals have no calcification, 62.2% had partial calcification, and 6.7% had total calcification. CONCLUSION: The normal dimensions, shape, and bridging of the sella turcica can be used by the orthodontist for diagnosis, treatment planning, and evaluation of various pathological conditions associated with the sella turcica.

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SUMMARY: This study evaluated the effects of ethnicity, sex, and age on the linear dimensions of the sella turcica (ST) and the pneumatization patterns of the sphenoid sinus (SS). In this cross-sectional retrospective study, we examined digitally standardized computed tomography scans of 100 Jordanians. These study participants comprised 50 men and 50 women, and their age ranged from 23 years to 77 years. We assessed linear ST dimensions and SS pneumatization patterns and correlated this data to age and sex. Furthermore, we compared the data with different ethnic groups from previous studies. The mean (standard deviation [SD]) length, diameter, width, and depth of the ST were 9.98 (1.89) mm, 12.45 (2) mm, 11.96 (1.76) mm, and 8.38 (1.63) mm, respectively. The mean (SD) interclinoid diameter was 8.84 (2.03) mm. These measurements were not significantly correlated with sex or age. With regards to pneumatization patterns of the sphenoid sinus, the conchal type was observed in 2 % of the study participants. Presellar involvement was observed in 30 % of the patients. The sellar and postsellar type was observed in 66 % and 2 % of patients, respectively. In our study, ST measurements did not differ significantly between the sexes. Pneumatization patterns of the SS differed from the patterns reported for other races. The findings of this study could assist neurosurgeons, orthodontists, and forensic medical investigators in diagnosing and planning treatment for pituitary gland pathologies.

Este estudio evaluó los efectos de la etnia, el sexo y la edad sobre las dimensiones lineales de la silla turca y los patrones de neumatización del seno esfenoidal (SE). En este estudio retrospectivo transversal, examinamos tomografías computarizadas estandarizadas digitalmente de 100 jordanos. Los participantes del estudio comprendían 50 hombres y 50 mujeres entre los 23 y los 77 años de edad. Evaluamos las dimensiones lineales del SE y los patrones de neumatización del SE y correlacionamos estos datos con la edad y el sexo. Además, comparamos los datos con diferentes grupos étnicos de estudios previos. La media (desviación estándar) de la longitud, el diámetro, el ancho y la profundidad del SE fueron 9,98 (1,89) mm, 12,45 (2) mm, 11,96 (1,76) mm y 8,38 (1,63) mm, respectivamente. El diámetro interclinoideo medio era de 8,84 (2,03) mm. Estas medidas no se correlacionaron significativamente con el sexo o la edad. Con respecto a los patrones de neumatización del seno esfenoidal, el tipo conchal se observó en el 2 % de los participantes del estudio. Se observó afectación preselar en el 30 % de los pacientes. El tipo selar y postsillar se observó en el 66 % y el 2 % de los pacientes, respectivamente. En nuestro estudio, las medidas del SE no difirieron significativamente entre los sexos. Los patrones de neumatización de la silla turca diferían de los patrones informados para otras razas. Los hallazgos de este estudio podrían ayudar a los neurocirujanos, ortodoncistas e investigadores médicos forenses en el diagnóstico y el tratamiento de las patologías de la hipófisis.

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Sella turcica development involves molecular factors and genes responsible for ossification. It is possible that single nucleotide polymorphisms (SNPs) in key genes are involved in morphological variation of sella turcica. Genes belonging to the WNT signaling pathway are involved in the ossification process and are candidates of sella turcica morphology. This study aimed to evaluate if SNPs in WNT6 (rs6754599) and WNT10A (rs10177996 and rs3806557) genes are associated with the calcification and patterns of the sella turcica. Nonsyndromic individuals were included in the research. Cephalometric radiographs were examined and the sella calcification was evaluated and classified according to the calcification of the interclinoid ligament (no calcification, partial calcification, and incomplete calcification) and sella turcica pattern (normal sella turcica, bridge type A-ribbon-like fusion, bridge type B-extension of the clinoid processes, incomplete bridge, hypertrophic posterior clinoid process, hypotrophic posterior clinoid process, irregularity in the posterior part, pyramidal shape of the dorsum, double contour of the floor, oblique anterior wall, and oblique contour of the floor). DNA samples were used to evaluate SNPs in the WNT genes (rs6754599, rs10177996, and rs3806557) using real-time PCR. Chi-square test or Fisher's exact test were used to compare the allele and genotype distributions according to sella turcica phenotypes. The alpha was set as 5% for all comparisons. A total of 169 individuals were included, 133 (78.7%) present sella turcica partially or completely calcified. Sella turcica anomalies were found in 131 individuals (77.5%). Sella turcica bridge type A (27.8%), posterior hypertrophic clinoid process (17.1%), and sella turcica bridge type B (11.2%) were the most prevalent morphological patterns observed. Individuals carrying the TT genotype in rs10177996 (TT vs. CT + CC) had higher chance to present a partially calcified sella turcica (p = 0.047; Odds ratio = 2.27, Confidence Interval 95% 1.01-5.13). In conclusion, the SNP in WNT10A is associated with the calcification phenotype of the sella turcica, the pleiotropic effect of this gene should be taken into consideration in future studies.

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Bone diseases are commonly found in the fossil record, especially in mammals of the Pleistocene megafauna, which exhibit signs of overload in the articulations. However, pathologies that affect soft tissues are not usually reported, even due to the nature of fossilization that rarely preserves such materials. In paleoneurological research using CT scan and three-dimensional reconstructions of Pleistocene sloths, an anomaly is discovered in the space that houses the pituitary gland, the sella turcica. The tomographic analysis of a Valgipes bucklandi skull revealed a great enlargement at the sella turcica, at the medial region in the body of the basisphenoid bone. The images delimit an enlarged dorsal-ventral projection, measuring approximately 15 mm height, at the tridimensional reconstructed endocranium. Taphonomic processes, such as the action of necrophagous agents, were discarded due to the shape and conditions of the structure, which also showed signs of bone remodeling. Thus, it is possible to affirm that a paleopathological process altered the size of the pituitary gland of the specimen MCT 3993-M, being probably a pituitary tumor.

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Pituitary adenomas (PAs) represent the most frequently found lesions in the sellar region; however, several other lesions may be encountered in this region, such as meningiomas, craniopharyngiomas, and aneurysms. High-quality imaging is fundamental for diagnosis, characterization, and guidance of treatment planning of PAs. Sellar magnetic resonance imaging (MRI) is considered the imaging modality of choice for the evaluation of lesions in the sella turcica. The sellar MRI standard protocol includes coronal and sagittal T1-weighted spin-echo sequencing with and without gadolinium-based contrast agent and coronal T2-weighted (T2w) fast-spin echo sequencing. A systematic MRI approach to the pituitary region generally provides information that includes the size and shape of the PA, the presence of cysts or hemorrhage within the tumor, its relationship with the optic pathways and surrounding structures, potential cavernous sinus invasion, sphenoid sinus pneumatization type, and differential diagnosis with other sellar lesions. The standard protocol is sufficient for the evaluation of most cases; however, some advanced techniques (susceptibility imaging, diffusion-weighted imaging, 3D T2w high-resolution sequences, magnetic resonance elastography, perfusion-weighted imaging) may render additional information, which may be important for some cases. In this "approach to the patient" manuscript, we will discuss the use of standard and advanced MRI sequences in the diagnosis and characterization of PAs, including MRI features associated with treatment response that may aid in presurgical evaluation and planning, and red flags that may point to an alternative diagnosis.

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BACKGROUND: The sella turcica volume is widely measured by the Di Chiro-Nelson method. The purpose is to compare the fidelity of a proposed volumetry method vs. the Di Chiro-Nelson method, using computed tomography (CT) images. MATERIALS AND METHODS: Morphometric examination of 173 CT scans were included, of which 52.6% were female. The mean age was 53.2 ± 17.6 years. Considering the Di Chiro-Nelson method, two measurements were added for each axis in the CT evaluation: length (central, left, and right), width (central, anterior, and posterior), and height (central, left, and right). RESULTS: The mean measurements were length: central 10.11 ± 1.44, left 7.45 ± 1.67, right 7.53 ± 1.59; width: central 12.27 ± 2.11, anterior 10.99 ± 1.92, posterior 10.10 ± 1.74; height: central 7.68 ± 1.38, left 7.16 ± 1.35, right 7.40 ± 1.41. A statistically significant difference between sexes was found only in the anterior width (p = 0.01). Using the proposed method, the volume was 342.2 ± 88.5 and 378. 6 ± 113.9 mm³, respectively for females and males (p = 0.02) vs. 476.1 ± 132.4 and 523.8 ± 186.0 mm3 (p = 0.05) using the Di Chiro-Nelson's method. CONCLUSIONS: Women had significantly smaller sella turcica volume than men. This proposed method considers the sella turcica as a not strictly symmetrical structure and indicates reduced variation between the maximum and minimum values, compared to the Di Chiro-Nelson's. Our findings may be useful for reassessment the volume of the sella turcica as the measurements indicate a higher precision.

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