Basilar expansion of the human sphenoidal sinus: an integrated anatomical and computerized tomography study

Haetinger, Rainer Guilherme; Navarro, João Adolfo Caldas; Liberti, Édson Aparecido

doi:10.1007/s00330-006-0208-3

Cited by 30 publications

(17 citation statements)

References 19 publications

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“…During the development of the sphenoid sinus, aerial expansion of the sinus occurs through trabecular bone resorption, leaving a thin bony wall at some points of the clivus and sphenoid. 18,21 Additional functional factors such as pulsating effects of arteries 15 or continuous pressure pulses of CSF may ultimately lead to a continuity defect and CSF leak. 17 This is illustrated in two independent cases of clival CSF leaks in saxophone players.…”

Section: Discussionmentioning

confidence: 99%

Primary Spontaneous Cerebrospinal Fluid Leaks Located at the Clivus

Zele

Kitice²,

Vellutini³

et al. 2013

Allergy�Rhinol (Providence)

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Transclival meningoceles and primary spontaneous cerebrospinal fluid (CSF) leaks at the clivus are extremely rare lesions and only few of them have been reported in the literature. We report here six cases of transclival primary spontaneous CSF leaks through the clivus. A retrospective case study was performed. We reviewed six cases involving sinonasal CSF leaks located at the clivus treated between 1997 and 2009. Presenting symptoms, duration of symptoms, defect size, site of defect, surgical approach and technique of defect closure, intraoperative complications, postoperative complications, and recurrences are discussed. All CSF leaks were located in the upper central part of the clivus. two of six patients showed signs of increased intracranial pressure (ICP) including arachnoid pits and/or empty sella. For three patients a purely transnasal approach was used with multilayer reconstruction using a nonvascularized graft, and three patients underwent a transnasal transseptal approach with a multilayer reconstruction, with nasoseptal flap. No recurrences of CSF leaks at clivus or other sites were observed to date with a mean follow-up of 10.3 years (range, 3–15 years). Spontaneous CSF rhinorrhea located at the clivus is an extremely rare condition. To date, only eight cases have been described. Here, we report the largest group of six consecutive cases. Irrespective of the used reconstruction technique in all cases a 100% closure rate was achieved. However, identification of increased ICP is an essential aspect and this condition should be treated either medically or surgically.

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Section: Discussionmentioning

confidence: 99%

Primary Spontaneous Cerebrospinal Fluid Leaks Located at the Clivus

Zele

Kitice²,

Vellutini³

et al. 2013

Allergy�Rhinol (Providence)

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“…In the drainage of inflammatory processes involving the sphenoid sinus (mucoceles, mucopyoceles, fungal sinusitis, etc.) and in procedures of the pituitary gland, it is important to know how far the sinus extends in the posterior direction [9]. Therefore, Line 6 is important to the effort of the surgeon in fully removing the lower part of the lesion.…”

Section: Discussionmentioning

confidence: 99%

Surgical Measurement of the Sphenoid Sinus on Sagittal Reformatted CT in the Turkish Population

Kaplanoğlu

Toprak

et al. 2013

EAJM

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Objective: The objectives of this study were to determine sinus measurements specific for the Turkish population using CT sagittal thin-slice reconstruction images and to clarify the three-dimensional anatomical features of the sphenoid sinus, along with its surrounding structures, that are relevant to performing an endoscopic sphenoidotomy. Materials and Methods:Images of 300 patients (165 female, 135 male) were studied. The research was conducted on the axial plane with a 1 mm slice thickness and a 0.6 mm slice interval, and sagittal reconstruction was performed with a 0.4 mm slice interval. Measurements of the sinus were obtained, and the presence of Onodi cells was researched.Results: Line 1 was found to be significantly shorter in the Turkish patients of this study compared to studies of other populations. Lines 4 and 6 were found to be longer on the left side (Line 4 right: 18.8±3.6 mm, left: 19.3±3.4 mm, p=0.027; Line 6 right: 24.1±6.8 mm, left: 24.3±6.8 mm, p=0.008). Lines 2, 3, 4 and 6 were longer in men than in women (p<0.05). Conclusion:In the Turkish population, Line 1 is shorter, so the risk of skull base perforation is greater. Lines 4 and 6 are longer on the left side; thus, choosing the left ostium in sinus dilation is safer. Because of sex differences regarding Lines 2, 3, 4 and 6, sex should be considered in sphenoid sinus procedures.

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“…Therefore, it truly represents an anatomical variation and is of no clinical significance. Pneumosinus dilatans is an abnormally expanded, airfilled paranasal sinus that extends beyond the margins of the "mother" bone, but shows normal thickness of the sinus walls [7]. Most commonly, this is an idiopathic condition;…”

Section: Paranasal Sinusesmentioning

confidence: 99%

Skull base: pseudolesion or true lesion?

Schmalfuss

Camp

2008

Eur Radiol

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The skull base is a complex anatomical structure. Therefore, radiologists often use "side-to-side" comparison for detection of abnormalities. This approach is compromised by the high frequency of anatomical variations involving the skull base and the common presence of flow-related artifacts within vessels at the skull base that might mimic true lesions. The spectrum of "pseudolesions" ranging from different anatomical variations, such as unusual arachnoid granulations, asymmetric pneumatization and/or appearance of neurovascular foramina, to flow-related artifacts will be discussed in this review article, and tips for their distinction from a true lesion in a similar location will be given.

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Basilar expansion of the human sphenoidal sinus: an integrated anatomical and computerized tomography study

Cited by 30 publications

References 19 publications

Primary Spontaneous Cerebrospinal Fluid Leaks Located at the Clivus

Primary Spontaneous Cerebrospinal Fluid Leaks Located at the Clivus

Surgical Measurement of the Sphenoid Sinus on Sagittal Reformatted CT in the Turkish Population

Skull base: pseudolesion or true lesion?

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