Anatomical landmarks for localisation of the anterior ethmoidal artery: a combined radiological and cadaveric (endoscopic) study

Abstract

Purpose The anterior ethmoidal artery is a major surgical landmark that is susceptible to iatrogenic injury during surgery of the anterior ethmoidal sinus, frontal sinus, and skull base. The present study aimed to define the location of the anterior ethmoidal artery in relation to specific anatomical landmarks using radiological imaging and endoscopic dissection. Methods Eighty-six anterior ethmoidal arteries were assessed using computed tomography scans (bilateral analyses) and forty anterior ethmoidal arteries were assessed using cadaveric specimens (bilateral analyses). The skull base, anterior nasal spine, anterior axilla of the middle turbinate, and nasal axilla were morphometrically analysed to determine their reliability as anterior ethmoidal artery landmarks. Results Distances to the skull base, anterior nasal spine, and nasal axilla displayed statistically significant differences between sexes and sides (p < 0.05). All landmarks demonstrated excellent reliability as anatomical landmarks for the localisation of the anterior ethmoidal artery, radiologically and endoscopically (ICC values ranged from 0.94 to 0.99). Conclusion The middle turbinate axilla was the most reliable landmark, due to the lack of statistically significant differences according to sex and laterality, and the high inter-rater agreement between measurements. Anatomical knowledge of variations and relationships observed in the present study can be applied to surgeries of the anterior ethmoidal sinus, frontal sinus, and skull base to improve localisation of the anterior ethmoidal artery, preoperatively and intraoperatively, and avoid iatrogenic injury of the vessel.

Comparing Endoscopic Measurements of the Anterior and Posterior Ethmoidal Arteries with CT Measurements: A Cadaveric Study

“…Lee et al stated that the distance from the MTA to the artery was 20 mm on average in their cadaver anatomical study, and it was accepted that it had the least variation both within and between individuals (12). Similar to this study, in another study the MTA was the most dependable anatomic landmark to localize the artery (11,13). In addition to these studies, in a radiological study the average distance from the MTA to the AEA was 1.88 cm (6).…”

The Complete Anatomy of the Anterior Ethmoidal Artery: A Meta-Analysis with Implications for Sinus and Skull Base Surgery

“…Initially, 2583 articles underwent evaluation. Ultimately, 38 articles met the required criteria and were included in this meta-analysis [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ]. The studies that were included in the analysis presented a low risk of bias in the AQUA score [ 50 ].…”

“…Year of Publication Continent Country Method Arteries Studied Livashin Naidu [24] 2023 Africa South Africa CT + Cadavers 126 Nikma Fadlati Umar [26] 2022 Asia Malaysia CT 370 Melih Caklili [48] 2021 Asia Turkey Cadavers 6 Gian Luca Fadda [44] 2021 Europe Italy CT 440 Amr F. Hamour [40] 2020 North America Canada CT 60 Mustafa Cemil Kilinc [37] 2020 Asia Turkey Cadavers + CT 14 Mohamed A. Taha [28] 2020 North America USA CT 100 Teppei Takeda [27] 2020 Asia Japan CT 366 [26] 2022 Asia Malaysia CT 370 Melih Caklili [48] 2021 Asia Turkey Cadavers 6 Gian Luca Fadda [44] 2021 Europe Italy CT 440 Amr F. Hamour [40] 2020 North America Canada CT 60 Mustafa Cemil Kilinc [37] 2020 Asia Turkey Cadavers + CT 14 Mohamed A. Taha [28] 2020 North America USA CT 100 Teppei Takeda [27] 2020 Asia Japan CT 366 Mohammad Waheed El-Anwar [4] 2019 Africa/Asia Egypt CT 300 Baharudin Abdullah [51] 2018 Asia Malaysia CT 252 Jasmine P. Y. Kho [38] 2018 Asia Malaysia CT 108 Ana M. Lemos-Rodriguez [34] 2018 North America USA Cadavers 8 Marco Ferrari [43] 2017 Europe Italy Cadavers 28 Vinicius Tomadon Bortoli [33] 2017 South America Brazil CT 600 Eric Mason [32] 2015 North America USA CT 100 David W. Jang [39] 2014 North America USA CT 78 Young-Bum Ko [5] 2014 Asia South Korea CT 119 Yu Zong [25] 2014 Asia China Cadavers 16 Erdem Eren [45] 2013 Asia Turkey CT 298 Christian Güldner [41] 2011 Europe Germany CT 282 Francisco G. Pernas [31] 2011 North America USA CT 138 [20] 2010 Asia India CT 100 Bashar Abuzayed [49] 2009 Asia Turkey Cadavers 24 C. Arturo Solares [30] 2009 North America USA CT 8 You-xiong Yang [11] 2009 Asia China Cadavers 28 S. E. McDonald [21] 2008 Europe United Ki...…”