Transethmoidal approach to the optic canal: Surgical and radiological microanatomy

Morphological Characteristics of the Anterior Ethmoidal Artery in Ethmoid Roof and Endoscopic Localization

“…Due to AEA's importance as an anatomical reference point for anterior skull base and frontal recess, 1,2,8,19 accurate localization of the artery is crucial during endoscopic sinus surgery. Because the AEA is parallel to the ethmoid roof, inferior to the anterior skull base, and superior to the ethmoid sinus, it can be used as a boundary between the ethmoid sinus and anterior skull base.…”

“…The AEA was identified at point a 1 , where the artery penetrated the lamina papyracea, into the anterior ethmoidal canal. Point a 3 was defined as the intracranial end of the AEA, and point a 2 was indicated as the midpoint of the curved line from a 1 to a 3 ( Fig.…”

“…Due to the special anatomical course in the ethmoid roof, which is behind the posterior border of the frontal recess or the floor of the anterior skull base, the anterior ethmoidal artery (AEA) is regarded as an important anatomical landmark in the surgical approach to the frontal recess and the anterior skull base. 1,2 However, its deep position, multiple variations, and complicated connections with adjacent structures make it a high-risk area 3 for the surgeon. Damage to the artery during surgery may cause serious complications, such as intense bleeding, cerebrospinal fluid leak, orbit hematoma due to artery retraction toward the intraorbital region, and even cerebral infections.…”

Role of the superior turbinate when performing endoscopic endonasal transsphenoidal approach

“…There is a major risk of adverse events when there is poor orientation and a blind operation is performed. There is marked projection of the posterior ethmoid cells over and into the sphenoid sinus in 8.4-25% of the cases [1,12,14,17,19]. This often makes sphenoid sinus identification even more difficult and at times dangerous.…”

Orbital size measurement based on computed tomography imaging for surgical safety

“…For surgical exploration of the orbit, the distances between the bony margin to the unsafe zone (superior and inferior orbital fissure, ethmoidal vessels) and the critical zone (optic canal) need to be determined [3,13,23]. Based on the analysis of the obtained results it was established that the safe space (distance between the bony margin of the orbit and the optic canal) in each of the orbital wall is approximately 40 mm.…”