In our hands, the success rate of endoscopic fistula repair was high, even in defects larger than 2 cm. Success rates may be further improved with accurate diagnosis of elevated intracranial pressure, a contributing factor to failure of spontaneous fistula repair.

Nineteen patients (17.43%) had isolated sphenoiditis, 6 (5.5%) fungal sinusitis, 30 (27.52%) mucocele, 6 (5.5%) fibrous dysplasia, 6 (5.5%) meningoencephalocele, 5 (4.58%) inverted papilloma, 4 (3.66%) epidermoid carcinoma, 10 (9.17%) liquor fistula, 1 (0.9%) rhabdomyosarcoma, 1 (0.9%) chordoma, and 1 (0.9%) had carotid pseudoaneurysm. Evidence of definitive diagnosis by endoscopy was obtained in less than half of the cases. CT scan, however, sometimes in combination with MRI, determined the pathology in all the cases. A follow-up of at least 4 years post-surgery showed good results in all the patients who underwent endoscopic transethmoidal sphenoidotomy.

With the use of this technique, the surgeon can precisely identify the position of the surgical instrument without losing his or her way, thereby significantly reducing the rate of complications.

Several studies demonstrated that the AEC is not always continuous in its bony structure, but it may show a partial or complete bone dehiscence in its most caudal portion. 1,3,4 Significant intrasubject side-to-side variability may exist so that the bony canal can be complete on one side and partially or completely open on the other one.Moreover, useful information about the distance of the AEA from the columella, 5 the middle turbinate axilla and the nasal valve 1,6 has been provided. AbstractIntroduction The clinical relevance of the anatomy and variations of the anterior ethmoidal artery (AEA) is outstanding, considering its role as a landmark in endoscopic surgery, its importance in the therapy of epistaxis, and the high risks related to iatrogenic injuries. Objective To provide an anatomical description of the course and relationships of the AEA, based on direct computed-tomography (CT)-based 3D volume rendering. Methods Direct volume rendering was performed on 18 subjects who underwent (CT) with contrast medium for suspected cerebral aneurism. Results The topographical location of 36 AEAs was assessed as shown: 10 dehiscent (27.8%), 20 intracanal (55.5%), 6 incomplete canals (16.7%). Distances from important topographic landmarks are reported. Conclusion This work demonstrates that direct 3D volume rendering is a valid imaging technique for a detailed description of the anterior ethmoidal artery thus representing a useful tool for head pre-operatory assessments.

With the use of this technique, the surgeon can precisely identify the position of the surgical instrument without losing his or her orientation, and thereby significantly reduce the risk of complications.

No abstract

The AEA was identified in all the patients treated. In 299 patients we found the AEA located at the level of the horizontal portion of the frontal bone into the anterior ethmoidal canal; in 88 (29.4%) of these patients the canal bone was partially open and in 211 (70.6%) it was completely closed. In only one patient, we found a dehiscent AEA. No patients presented short-term failure and/or long-term failure.

Introduçaõ:A importância da compreensão da anatomia interna do seio esfenoidal deve-se à sua peculiar localização no centro do crânio, com estruturas vizinhas de nobreza indiscutível, e por transparecer estas relações anatômicas em suas delgadas paredes internas. Forma de estudo: Anatômico. Material e método: No presente estudo foram dissecados endoscopicamente 52 seios esfenoidais, sendo suas saliências e depressões internas analisadas, correspondentes aos relevos internos produzidos pela artéria carótida interna, nervo óptico, nervo maxilar, e nervo vidiano. Resultado: Em 88,5% dos casos a artéria carótida interna apresentou-se saliente, e o nervo óptico o fez em 55,8%. O nervo vidiano e o nervo maxilar mostraram-se visíveis em 25% e 30,8% dos casos, respectivamente. Conclusão: Tais dados nos chamam a atenção para a rica e frágil anatomia interna do seio esfenoidal que, devido ao avanço dos métodos de cirurgia endoscópica, está progressivamente mais próxima e vulnerável a manobras e procedimentos cirúrgicos. Assim, sua compreensão torna-se essencial quando se trata de cirurgia endoscópica endonasal e seu horizonte de recursos técnicos. Introducti on:The internal anatomy of the sphenoid sinus plays a role of great importance due to its peculiar placement in the center of the head, surrounded by important adjacent structures, which make themselves transparent in its internal walls. Study design: Anatomic. Material and method: In this study, 52 sphenoid sinus were endoscopically dissected, and the elevations and depressions presented on its internal walls, produced by the internal carotid artery and the optic, maxillary and vidian nerves, were analyzed. Results: In 88,5% of the cases, the internal carotid artery were projected into the sinus, while the optic nerve were in 55,8%. The vidian and maxillary nerves were salient in 25% and 30% respectively. Conclusion: These data point us to the rich end delicate internal anatomy of the sphenoid sinus, which is progressively closer and more vulnerable to surgical maneuvers, due to the advance of surgical skills, techniques and knowledge. Thus, the study and comprehension of the sphenoid sinus internal anatomy became essential, concerning the endoscopic sinus surgery and its huge field of technical resources. Rev Bras Otorrinolaringol. V.68, n.4, 522-5, jul./ago. 2002 Palavras-chave: seio esfenoidal, cirurgia endoscópica, artéria carótida interna, nervo maxilar, nervo óptico, anatomia. ORIGINAL ARTICLE ARTIGO ORIGINAL