Intrasphenoid septations inserted into the internal carotid arteries: a frequent and risky relationship in transsphenoidal surgeries

Ramalho, Clauder Oliveira; Marenco, Horácio Armando; Filho, Francisco de Assis Vaz Guimarães; Costa, Marcos Devanir Silva da; Santos, Bruno Fernandes de Oliveira; Santos, Rodrigo de Paula; Zymberg, Samuel Tau

doi:10.1016/j.bjorl.2016.02.007

Cited by 6 publications

(6 citation statements)

References 16 publications

(27 reference statements)

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“…The inter-sphenoid septum (ISS) is an important anatomical landmark within the SS; it varies in number and point(s) of insertion on the sinus wall but often inserting on the bony covering of the ICA. Previously reported the prevalence of ISS insertion into ICA bony covering ranges from 4.9% to 89%151920 and in our study, the prevalence is 31.6%. During endoscopic surgery, the septum must be removed to expose the sella floor, thereby creating adequate surgical corridor 20.…”

Section: Discussionsupporting

confidence: 56%

Sphenoid sinus pneumatization, septation, and the internal carotid artery: A computed tomography study

et al. 2018

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Background: The air spaces of the nasal cavity and the sphenoid sinus (SS) constitute a convenient corridor to access lesions of the skull base using the endoscopic endonasal transsphenoidal approach (EETA). Safe EETA depends on the SS and skull base anatomy of the patient. Individual variations exist in the degree and pattern of SS pneumatization. This study aims to examine the variations in SS pneumatization, the inter-sphenoid septum (ISS), and their relationship with the internal carotid artery (ICA) among adult Nigerians. Materials and Methods: We reviewed computerized tomography (CT) images of 320 adult patients that had imaging for various indications. This excluded those with traumatic, inflammatory, or neoplastic process that may alter anatomical landmarks. The images were evaluated for the types of SS pneumatization, number and insertion of ISS, and the protrusion of ICA into the sinus cavity. Results: Prevalence of SS pneumatization types: 1.9% conchal, 1.2% presellar, 56.6% sellar, and 40.2% postsellar. The lateral extension of SS occurred into the pterygoid in 138 patients (45.1%), greater wing 112 (35%), lesser wing 37 (11.6%), the full lateral type was seen in 97 (30.3%) patients. One ISS occurred in 150 (46.9%) patients, 162 (50.6%) had multiple, and 8 (2.5%) had none. ISS insertion into ICA bony covering occurred in 101 (31.6%) patients, whereas protrusion of ICA into SS cavity occurred in 110 (34.4%) patients. Conclusion: Variations of the SS, ISS, and ICA anatomy are present among native Africans. Detailed imaging evaluation of each patient is considered for EETA is mandatory.

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Section: Discussionsupporting

confidence: 56%

Sphenoid sinus pneumatization, septation, and the internal carotid artery: A computed tomography study

et al. 2018

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“…But it often inserts on the bony covering of the ICA. In previous studies the prevalence of inter sphenoid septum insertion into the bony covering of ICA in between 4.9%-89% and in our study the prevalence is (30,31,32) 31%(n=31). While performing endoscopic trans sphenoidal surgery, the septa should be removed for exposing oor of sella turcica, thereby creating adequate surgical corridor .And it should be done with (32) extreme caution and without making avulsion fracture of the septum.…”

supporting

confidence: 60%

Variations of Surgicalanatomy in and Around Sphenoid Sinus: A Computed Tomographic Study

Ghosh

Bandopadhyay

Singh

et al. 2020

ijsr

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Radiological anatomy is evaluated in three dimensions for preoperative and paroperative sur-gical planning, which helps the surgeon to identify his or her limits of dissection during sur-gery and avoid complications. Patients attending OPD at Institute of Otorhinolaryngology and Head & Neck Surgery, Kol-kata, India with features of sinonasal disease were advised CT scan depending upon the symptoms and course of the disease. 100 study subjects (200 sides) were selected during the study period between 01/01/2019 to 30/06/2020. Septa related directly related to ICA in 31%(n=31) cases of whom 12 patients (12%), 8 pa-tients (8%) and 11 patients (11%) had septa related to right ICA, left ICA and bilaterally ICA respectively. Septa attachment to optic nerve is seen in 27%(n=27) patients, of whom 10 patients (10%), 11 patients (11%) and 6 patients (6%) had attachment related to right optic nerve, left optic nerve and both optic nerves, respectively. On the right side ICA protrusion and pneumatization of ACP were both present in 8(8%) patients and on the left side in 7(7%) patients. Chi-Square test indicated a statistically significant association (P < 0.001). Pneumatized ACP and ON protrusion consistently en-countered on the right and left side in 7 patients (7%) and 8 patients (8%) respectively. Chi-Square test indicated a significant association between ACP pneumatization and ON protru-sion (P<0.001). This resolution helped in better demonstration of complicated sphenoid sinus anatomy well. Hence, we support 1 mm triplaner CT Scans for preoperative imaging assessment for all sinus surgeries.

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“…This figure is quite similar to the study of CT scan of 421 patients done by Ramalho CO et al, who found prevalence of 52%. 19 Fernandez-Miranda et al, showed radiologic prevalence of 85% among patients with at least one septation attached to carotid protuberance. 20 Other studies have quoted lower figures in this respect.…”

Section: Pattern Of Septationmentioning

confidence: 99%

Anatomical variations of sphenoid sinus on multi-detector computed tomography and its usefulness in trans-sphenoidal endoscopic skull base surgery

Lokwani¹,

Patidar²,

Parihar³

2018

Int J Res Med Sci

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Background: Knowledge of sphenoid bone and sinus anatomy and its variations is of central importance in transsphenoidal endoscopic skull base surgery. It allows endoscopic surgeon to safely approach the sella turcica, anterior skull base and orbit. The aim of the study was to evaluate the different anatomical variations of the sphenoid sinus that are relevant to trans-sphenoid endoscopic skull base surgery on multi-detector computed tomography.Methods: A prospective observational study of the CT analysis of the anatomical variations and various dimensions of sphenoid sinus relevant to trans-sphenoidal endoscopic neurosurgery was performed in 260 patients (173 male; 87 female).Results: The average presellar width of sphenoid sinus on axial CT scan images was 11.75mm (7.2 to 18.6mm). Average value of maximum width of sphenoid sinus was 30.52 mm (13.1 to 42.2 mm). The most common pattern of inter-sphenoid septum was single septum which was present in 207 patients (79.61%); double inter sphenoid septum in 47 patients (18.1%) and diverging septa in 13 patients (5%). 138 out of 260 subjects (53%) showed at least one septum attached to either carotid protuberance. Most common pattern of pneumatization in sphenoid sinus was sellar type (63.46%). Average suprasellar depth was 10.78 (5.4 to 18.7mm). Average presellar depth of sphenoid sinus was 13.47mm (8.1 to 22.5mm). Average infrasellar depth of sphenoid sinus was 25.46mm (11.9 to 37.9mm). Average presellar height of sphenoid sinus was 21.27mm (13 to 27.6mm).Conclusions: A preoperative review of the sphenoid sinus anatomy by CT allows safer endoscopic management of skull base pathology preventing injury to vital structures surrounding the sphenoid sinus.

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Intrasphenoid septations inserted into the internal carotid arteries: a frequent and risky relationship in transsphenoidal surgeries

Abstract: The frequency of intrasphenoid septations in the ICAp found is considerable. It is higher among patients with more pneumatised sinuses. This finding justifies an appropriate pre-operative study, and careful attention must be paid during transsphenoidal surgery.

Cited by 6 publications

References 16 publications

Sphenoid sinus pneumatization, septation, and the internal carotid artery: A computed tomography study

Sphenoid sinus pneumatization, septation, and the internal carotid artery: A computed tomography study

Variations of Surgicalanatomy in and Around Sphenoid Sinus: A Computed Tomographic Study

Anatomical variations of sphenoid sinus on multi-detector computed tomography and its usefulness in trans-sphenoidal endoscopic skull base surgery

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