In Vivo Computed Tomography Direct Volume Rendering of the Anterior Ethmoidal Artery: A Descriptive Anatomical Study

Abstract

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.

A Simple Clinical Application for Locating the Anterior Ethmoidal Artery Using the Anterior Ethmoidal Foramen and the Anterior Nasal Spine

“…2 It then reaches the ethmoidal sinus, passing through the bony anterior ethmoidal canal (AEC), finally getting into the olfactory fossa through the lateral lamella of the cribriform plate. 5 The AEA exhibits considerable variability in terms of distance from the frontal sinus and the skull base 1; it may be closely apposed to the skull base, or it may traverse the ethmoids, either freely or within a bony canal. 6,7 Poor recognition of this variation places the artery at risk during ESS, as injury to the AEA may result in severe consequences such as massive hemorrhage, vision loss, periorbital or intraorbital hematoma, and cerebrospinal fluid rhinorrhea, among others.…”

Estudo dos canais etmoidais em peças anatômicas sob visão endoscópica e análise histológica

“…A classificação de Yenigun foi definida como: comprimento anteriorposterior da placa cribriforme, tipo 1: 6-10 mm (Figura 1a), tipo 22,39 .…”

“…Além disso, a identificação da AEA torna-se muito mais difícil na vigência de uma doença inflamatória do recesso frontal 22,39 .…”

“…Ademais, concorda-se que não há diferenças significativas entre os gêneros (masculino e feminino), porém, há discordância quanto à etnia (negros, pardos, caucasianos, entre outros) 22,39,40 .…”

“…Muitas vezes, há um ramo meníngeo na dura-máter, enquanto ainda está contido no crânio 34 . Esta artéria fornece os seios arteriais etmoidais posteriores à dura-máter da fossa craniana anterior e à parte superior da mucosa nasal do septo nasal 34 24,39,50 .…”