Sphenoid septations and their relationship with internal carotid arteries: Anatomical and radiological study

Metgudmath²,

Int J Otorhinolaryngol Head Neck Surg

et al. 2019

Background:The approach to sphenoid sinus still remains a clinical challenge, despite the arrival of endoscopy, computed tomography (CT) and functional endoscopic sinus surgery (FESS). The complex and variable anatomy of the sphenoid sinus can be difficult to appreciate with standard axial or coronal CT images of the sinus. The study was done with the objective to study the anatomy of the sphenoid sinus and its variations, and to compare the prevalence of variants obtained in our study with the reported cases in the literature. Methods: The CT scans of 168 normal slides obtained from 84 patients with paranasal sinus were analysed using triplanar imaging provided by 64-slice spiral CT. The prevalence of each of the sphenoid sinus variation was also analysed. Results: Results showed that the prevalence of pneumatization of the anterior clinoid process, greater wing of the sphenoid, and the pterygoid process was 17.85%, 22.61% and 32.14%, respectively. Protrusion of the internal carotid artery, optic nerve, maxillary nerve, and the vidian nerve was 47.61%, 36.90%, 25% and 26.19%, respectively. Dehiscence of internal carotid artery, optic nerve, maxillary nerve, and the vidian nerve was 30.95%, 29.76%, 14.28% and 22.61%, respectively. The prevalence of pneumatization in the Onodi cells was seen in 17.85% of the cases. Association of septa with an internal carotid artery was seen in 29.7% of the cases. Septa attachment to the optic nerve was also observed in 27.3% of the cases. Conclusions: The triplanar imaging (section thickness of 1 mm) is a better three-dimensional image of the sphenoid sinus, compared to coronal imaging. Triplanar imaging guides the surgical approach of the sphenoid sinus with mentally reconstructed three-dimensional images.

Section: Discussionsupporting

confidence: 48%

Anatomical variations of sphenoid sinus among patients undergoing computed tomography of paranasal sinus

Metgudmath²,

Int J Otorhinolaryngol Head Neck Surg

et al. 2019

“…In this retrospective study with the largest number of cases (n= 314) on this topic in the literature, we examined the parameters that have also reported previously in medical literature such as the degree of sphenoidal pneumatization, number and configuration of the sphenoid septa, the existence and the degree of the sellar bulging (2,5,6,9,10).…”

Section: Discussionmentioning

confidence: 99%

The Relationship between the Variations of Sphenoid Sinus and Nasal Septum

Battal¹,

Akay²,

Karaman³

et al. 2014

Gulhane Med J

The aim of this article is to discuss the sphenoid sinus variations that could be important for transsphenoidal pituitary surgery planning. 314 computed tomography angiography performed with 64-detector multi-slice scanner of the head and neck region in consecutive patients were studied. Thin slices axial, coronal and sagittal, maximum intensity projection and multiplanar reformatted images were obtained for detailed evaluation. 57 cases had presellar (18.2%), 40 patients had sellar (12.7%), 214 patients (68.2%) had postsellar and 3 patients (1%) had conchal pneumatization. We identified sellar bulging in 249 of 314 cases (79.3%), (43% mild, 36.3% prominent). We detected more than one septum in 107 cases (34.1%). In 4 cases (1.3%) we could not define any septum. Nasal septum was deviated to the right in 129 cases (41.1%), deviated to the left in 140 cases (44.6%) and non-deviated in 45 patients (14.3%). There was statistically significant difference in the mean distances between the deviated main sphenoid septum and the internal carotid arteries on the deviation and opposite sides. Knowing the nasal septal deviation direction does not facilitate to predict the direction of the deviation of the main sphenoid septum. Reporting important anatomical variations routinely in computed tomography and/or magnetic resonance imaging reports in transsphenoidal pituitary surgery candidates may reduce transsphenoidal pituitary surgery complications during surgery. ÖZET Nazal septum ve sfenoid sinüs varyasyonları arasındaki ilişkiBu çalışmanın amacı, Transsfenoidal Hipofiz Cerrahisi planlanması için önemli olabilecek sfenoid sinüs varyasyonlarını tartışmaktır. Ardışık 314 hastada başboyun bölgesine yönelik 64-dedektör kesitli tarayıcı ile yapılan bilgisayarlı tomografi anjiyografi tetkikleri incelendi. İnce aksiyel, koronal ve sagital kesitler, maksimum intensite görüntüler ve multiplanar reformat görüntüler ayrıntılı değerlendirme için elde edildi. 57 olguda (% 18.2) presellar, 40 olguda sellar (% 12.7), 214 olguda (% 68.2) postsellar ve 3 olguda (% 1) konkal pnömatizasyon vardı. 314 olgunun 249' unda (% 79.3) sellar taşma (% 43 hafif, % 36.3 belirgin) tanımladık. 107 olguda (% 34.1) birden fazla septum tespit ettik. 4 olguda (% 1.3) herhangi bir septum tanımlayamadık. Nazal septum 129 olguda (% 41.1) sağa, 140 olguda (% 44.6) sola deviye idi ve 45 hastada (% 14.3) deviasyon yoktu. Deviye ana sfenoid septum ve internal carotid arterler arasında, deviasyon tarafındaki ve ters taraftaki ortalama mesafelerde istatistiksel olarak anlamlı fark vardı. Nazal septal deviasyon yönünü bilmek ana sfenoid septum deviasyonu yönünü tahmin etmeyi kolaylaştırmamaktadır. Transsfenoidal hipofiz cerrahisi adaylarının bilgisayarlı tomografi ve/veya manyetik rezonans görüntüleme raporlarında rutin olarak önemli anatomik varyasyonları raporlamak ameliyat sırasında cerrahi komplikasyonlarını azaltabilir.

Int Forum Allergy Rhinol

“…Morphometric studies have shown anatomical landmarks correlating with segments of the ICA . An anatomic and radiographic study by Fernandez‐Miranda et al . showed that intrasphenoidal septations most commonly attach to the ICA canal.…”

Section: Complicationsmentioning

confidence: 99%

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Self Cite

151

279

Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.