A Novel Use of a Landmark to Avoid Injury of the Anterior Ethmoidal Artery during Endoscopic Sinus Surgery

Pernas, Francisco G.; Coughlin, Andrew; Hughes, Sharon E.; Riascos, Roy; Maeso, Patricia

doi:10.2500/ajra.2011.25.3541

Cited by 23 publications

(31 citation statements)

References 16 publications

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“…7 Appropriate identification of the AEA is an important step to prevent its inadvertent injury or transection. 8 , 9 Others have correlated the posterior wall of the frontal sinus and the supraorbital ethmoidal cells with the location of the AEA. 10 , 11 However, the course of the AEA and the relationship between the supraorbital cells are variable.…”

Section: Introductionmentioning

confidence: 99%

Intraconal Anatomy of the Anterior Ethmoidal Neurovascular Bundle: Implications for Surgery in the Superomedial Orbit

London

Prevedello

et al. 2020

Am J Rhinol�Allergy

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Background The anterior ethmoidal artery (AEA) branches from the ophthalmic artery in the superomedial intraconal space. The feasibility of management of lesions arising from the superomedial intraconal space via an endoscopic endonasal approach has not been sufficiently explored. Objective To yield a detailed anatomic description of the anterior ethmoidal neurovascular bundle and its variants to serve as the foundation for possible management of lesions in the superomedial intraconal space. Methods Eight cadaveric specimens (16 sides) were dissected using an endonasal approach, tracing the AEA proximally through the superomedial intraconal space. Furthermore, the anatomy of adjacent structures was noted, and distances from the anterior ethmoidal foramen to the origin of the AEA at the ophthalmic artery were measured. Results Supraorbital cells were found in 13/16 sides (81.25%), and a bony dehiscence of the anterior ethmoidal canal was observed in 5/16 sides (31.25%). The nasociliary nerve, ophthalmic artery, superior division of the oculomotor nerve, superior rectus muscle, and levator palpebrae superioris were routinely identified in the superomedial intraconal space. The AEA passed through a corridor between the medial rectus and superior oblique muscles after arising from the ophthalmic artery (lateral to the foramen) in all specimens. The average distance from its origin to the anterior ethmoidal foramen was 5.19 ± 0.98 mm. Conclusion Anatomically, it is feasible to access the superomedial intraconal space via an endoscopic endonasal approach. This study provides the anatomical basis for procedures in the superomedial intraconal space.

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Section: Introductionmentioning

confidence: 99%

Intraconal Anatomy of the Anterior Ethmoidal Neurovascular Bundle: Implications for Surgery in the Superomedial Orbit

London

Prevedello

et al. 2020

Am J Rhinol�Allergy

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“…The anterior ethmoidal artery passes from the orbit to the anterior fossa of the skull through a canal within the ethmoid fossa. 1,2 Injury to the anterior ethmoidal artery within this canal is a complication that can occur during functional endoscopic sinus surgery (FESS), and may result in significant morbidity, including intra-operative haemorrhage, vasospasm, retraction into the orbit and subsequent sight-threatening retro-orbital haematoma. 2…”

Section: Introductionmentioning

confidence: 99%

An artificial intelligence algorithm that differentiates anterior ethmoidal artery location on sinus computed tomography scans

et al. 2019

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ObjectiveDeep learning using convolutional neural networks represents a form of artificial intelligence where computers recognise patterns and make predictions based upon provided datasets. This study aimed to determine if a convolutional neural network could be trained to differentiate the location of the anterior ethmoidal artery as either adhered to the skull base or within a bone ‘mesentery’ on sinus computed tomography scans.MethodsCoronal sinus computed tomography scans were reviewed by two otolaryngology residents for anterior ethmoidal artery location and used as data for the Google Inception-V3 convolutional neural network base. The classification layer of Inception-V3 was retrained in Python (programming language software) using a transfer learning method to interpret the computed tomography images.ResultsA total of 675 images from 388 patients were used to train the convolutional neural network. A further 197 unique images were used to test the algorithm; this yielded a total accuracy of 82.7 per cent (95 per cent confidence interval = 77.7–87.8), kappa statistic of 0.62 and area under the curve of 0.86.ConclusionConvolutional neural networks demonstrate promise in identifying clinically important structures in functional endoscopic sinus surgery, such as anterior ethmoidal artery location on pre-operative sinus computed tomography.

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“…Many landmarks for distance have been tested, such as the anterior nasal spine, the axilla of the middle turbinate, the lacrimal crest, and the frontal recess. 2,4,6,8,13,15 The aim of this study was to analyze and compare the measurements from the AEA to the ethmoid bulla and to the frontal beak through facial CT scan, while identifying their intraindividual and interindividual variations.…”

Section: Introductionmentioning

confidence: 99%

Study of Anthropometric Measurements of the Anterior Ethmoidal Artery using Three-dimensional Scanning on 300 Patients

Bortoli

Martins

Negri

2017

Int Arch Otorhinolaryngol

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Introduction The anterior ethmoidal artery (AEA) is one of the main arteries that supply both the nasal mucosa and the ethmoid sinuses. The AEA shows variability regarding its distance from adjacent structures. Several studies have developed techniques to identify the AEA. Objective This study aimed to compare the measurements from the AEA to the ethmoid bulla and to the frontal beak by using computed tomography of the face, while identifying their intraindividual and interindividual variations. Methods We analyzed 300 CT scans of the face performed at the CT scan Center at Hospital. The average age of subjects was 36 ± 15.1 years (range 4–84). Results We found that the average distance from the AEA to the ethmoid bulla was 17.2 ± 1.8 mm and the distance from the AEA to the frontal beak was 15.1 ± 2.2 mm. Regarding the average distance from the AEA to the frontal beak (AEA-frontal beak), there was a difference between the right and left sides, with the former being 0.4 mm higher on average than the latter. Among the age groups, there was a significant difference of distances between the AEA and the ethmoid bulla (AEA-ethmoid bulla), which were shorter in the ≤ 12 years group. There was a positive and significant correlation between both measurements analyzed, with low values (high) of AEA-ethmoid bulla distance corresponding to low values (high) of AEA-frontal beak distance. Conclusion The measurements obtained adds anatomical knowledge that can serve as a parameter in frontal and ethmoid sinus surgery.

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A Novel Use of a Landmark to Avoid Injury of the Anterior Ethmoidal Artery during Endoscopic Sinus Surgery

Cited by 23 publications

References 16 publications

Intraconal Anatomy of the Anterior Ethmoidal Neurovascular Bundle: Implications for Surgery in the Superomedial Orbit

Intraconal Anatomy of the Anterior Ethmoidal Neurovascular Bundle: Implications for Surgery in the Superomedial Orbit

An artificial intelligence algorithm that differentiates anterior ethmoidal artery location on sinus computed tomography scans

Study of Anthropometric Measurements of the Anterior Ethmoidal Artery using Three-dimensional Scanning on 300 Patients

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