Lateral lamella of the cribriform plate, a keystone landmark: proposal for a novel classification system

Gera, Roberto; Mozzanica, Francesco; Karligkiotis, Apostolos; Preti, Andrea; Bandi, Francesco; Gallo, Stefania; Schindler, Antonio; Bulgheroni, Claudia; Ottaviani, F.; Castelnuovo, Paolo

doi:10.4193/rhin17.067

Cited by 31 publications

(88 citation statements)

References 20 publications

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“…Table 4. Distribution of Gera 9 and TMS (Thailand-Malaysia-Singapore) classifications. Gera 9 and TMS classifications have no significant correlation (p = 0.804).…”

Section: Discussionmentioning

confidence: 99%

“…Distribution of Gera 9 and TMS (Thailand-Malaysia-Singapore) classifications. Gera 9 and TMS classifications have no significant correlation (p = 0.804). * Gera (Class I, low risk: the angle >80 degrees, Class II, medium risk: the angle ranged from 45 to 80 degrees, Class III, high risk: the angle <45 degrees).…”

Section: Discussionmentioning

confidence: 99%

“…Subsequently, the Gera classification 9 was proposed to consider the sloping level of ethmoidal roof (ER) relative to CP. By measuring the angle formed by the lateral lamella of CP and the continuation of the horizontal plane passing through CP, the risk of intracranial entry was divided into 3 classes; class I (>80 degrees, low risk), class II (45 to 80 degrees, medium risk) and class III (<45 degrees, high risk) 9,10 .…”

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confidence: 99%

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A new radiological classification for the risk assessment of anterior skull base injury in endoscopic sinus surgery

Abdullah

Chew

Aziz

et al. 2020

Sci Rep

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Keros and Gera classifications are widely used to assess the risk of skull base injury during endoscopic sinus surgery. Although, both classifications are useful preoperatively to stratify risk of patients going for surgery, it is not practical to measure the respective lengths during surgery. In this study, we aimed to propose a new radiological classification (Thailand-Malaysia-Singapore (TMS)) to assess the anatomical risk of anterior skull base injury using the orbital floor (OF) as a reference. A total of 150 computed tomography images of paranasal sinuses (300 sides) were reviewed. The TMS classification was categorized into 3 types by measuring OF to cribriform plate and OF to ethmoid roof. Most patients were classified as TMS type 1, Keros type 2 and Gera class II, followed by patients classified as TMS type 3, Keros type 1 and Gera class 1. TMS has significant correlation with Keros classification (p < 0.05). There was no significant correlation between Keros and Gera classifications (p = 0.33) and between TMS and Gera classifications (p = 0.80). The TMS classification has potential to be used for risk assessment of skull base injury among patients undergoing ESS. It serves as an additional assessment besides the Keros and Gera classifications.

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“…Table 4. Distribution of Gera 9 and TMS (Thailand-Malaysia-Singapore) classifications. Gera 9 and TMS classifications have no significant correlation (p = 0.804).…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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A new radiological classification for the risk assessment of anterior skull base injury in endoscopic sinus surgery

Abdullah

Chew

Aziz

et al. 2020

Sci Rep

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“…The clinical implication of deeper olfactory fossa and longer lateral lamella is clear. Lateral lamella of cribriform plate is the thinnest part of the skull base, which is known to be a common site of injury during sphenoethmoidectomy . The thickness of the lateral lamella, the most vulnerable part of the skull base, was reported to be only 0.05 mm .…”

Section: Discussionmentioning

confidence: 99%

“…Beside the length of the lateral lamella, the angle may also implicate that it might in part determine the association of lateral lamella with cribriform plate and fovea ethmoidalis. In a proposal based on the angle of the lateral lamella, Gera et al reported that the decreased angle of the lateral lamella was related to increased length. Thus, lateral lamellas with lower angles might be associated with a higher risk of iatrogenic injury.…”

Section: Discussionmentioning

confidence: 99%

Does paranasal sinus development affect olfactory fossa depth and lateral lamella length?

2019

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Objectives: To investigate the olfactory fossa depths and lateral lamella lengths of patients with different types of developmental disorders of paranasal sinuses in comparison with normal controls.Study Design: Retrospective, archival, radio-anatomical study. Methods: We included 58 patients with maxillary sinus hypoplasia, 50 patients with frontal sinus hypoplasia/aplasia, 50 patients with sphenoid sinus hypoplasia/aplasia, and 40 normal controls. Reviewing paranasal computerized tomography scans, we noted the olfactory fossa depths and lateral lamella lengths of all the groups and compared between the hypoplasia groups and the control group.Results: Compared with the normal controls, the maxillary hypoplasia group (P < 0.001), frontal hypoplasia/aplasia group (P = 0.004), and sphenoid hypoplasia/aplasia group had significantly deeper olfactory fossa (P = 0.003). The mean lateral lamella lengths in the type 1, type 2, and type 3 hypoplastic maxillary sinus groups were significantly greater compared with that in the control group (P < 0.001). Additionally, the mean lateral lamella lengths in the hypoplastic frontal sinus, aplastic frontal sinus, and hypoplastic sphenoid sinus groups were significantly greater compared with that in the control group (P < 0.001).Conclusion: The patients with pneumatization defects of the maxillary, frontal, and sphenoid sinuses had deeper olfactory fossa and longer lateral lamella related to increased risk of skull base injury during endoscopic sinus surgery.

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Skull Base Development and Anatomy

Terzakis

Chatzinakis²,

Georgalas³

2022

CSF Rhinorrhea

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Lateral lamella of the cribriform plate, a keystone landmark: proposal for a novel classification system

Cited by 31 publications

References 20 publications

A new radiological classification for the risk assessment of anterior skull base injury in endoscopic sinus surgery

A new radiological classification for the risk assessment of anterior skull base injury in endoscopic sinus surgery

Does paranasal sinus development affect olfactory fossa depth and lateral lamella length?

Skull Base Development and Anatomy

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