Endoscopic Sphenoid Sinus Anatomic Considerations: A Study on 60 Cadavers

Document Type : Original

Authors

Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Abstract

Introduction:
Sphenoid sinus can be considered a key element in advanced sinus and skull base surgery. Due to its importance, many researchers tried to document its characteristics and evaluate possible differences among different races and populations.
Materials and Methods:
This study was conducted between March 2017 and December 2018 on 60 fresh adult cadavers in Tehran Forensic Medicine Center, Tehran, Iran. The evaluated variables were distances between nasal spines, posterior wall of the sphenoid, pituitary gland, and the distance between the anterior and posterior ethmoid artery and optic nerve, which were calculated using a flexible ruler through the direct length in millimeter. Another important variable was dehiscence, which was evaluated in optic and carotid artery canals.
Results:
After dissecting 120 sphenoid sinuses, the carotid artery was dehiscent in 24 (20%) cases, and optic nerve dehiscence was observed in 15 (12.5%) cadavers. The mean distance between the anterior wall of the sphenoid sinus and the anterior nasal spine was determined at 73.3±1.3 mm (rang: 58.3-87 mm), and the mean distance between the anterior part of the middle of the pituitary gland and the anterior nasal spine was estimated at 81.1±1.6 mm.
Conclusion:
According to our finding, the dehiscence of the key structural organs may be more prevalent in the Persian sphenoid sinus, which should be considered carefully in the management of related pathologies. 

Keywords

References

  1. Yilmazlar S, H Kocaeli, Eyigor O, Hakyemez B. Clinical importance of the basal cavernous sinuses and cavernous carotid arteries relative to the pituitary gland and macroadenomas: quantitative analysis of the complete anatomy. Surgical neurology, 2008; 70(2): p. 165-174.
  2. Unlu, C Meco, HC Ugur, A Comert, Endoscopic anatomy of sphenoid sinus for pituitary surgery. Clinical Anatomy, 2008; 21(7): p. 627-632.
  3. Unal B, Bademci G, Bilgili YK, Batay F, Avci E. Risky anatomic variations of sphenoid sinus for surgery. Surgical and Radiologic Anatomy. 2006 May 1; 28(2):195-201.
  4. De Divitiis O, Conti A, Angileri FF, Cardali S, La Torre D, Tschabitscher M. Endoscopic transoral-transclival approach to the brainstem and surrounding cisternal space: anatomic study. Neurosurgery. 2004 Jan 1; 54(1):125-30.
  5. Alfieri A, Jho HD. Endoscopic endonasal approaches to the cavernous sinus: surgical approaches. Neurosurgery. 2001 Aug 1;49(2):354-62.
  6. Cavallo LM, Cappabianca P, Messina A, Esposito F, Stella L, de Divitiis E, Tschabitscher M. The extended endoscopic endonasal approach to the clivus and cranio-vertebral junction: anatomical study. Child's Nervous System. 2007 Jun 1; 23(6): 665-71.
  7. Ramakrishnan VR, Suh JD, Lee JY, O'Malley BW, Grady MS, Palmer JN. Sphenoid sinus anatomy and suprasellar extension of pituitary tumors. Journal of neurosurgery. 2013 Sep 1; 119(3): 669-74.
  8. Araújo Filho BC, Neto CP, Weber R, Voegels RL. Sphenoid sinus symmetry and differences between sexes. Rhinology. 2008 Sep 1; 46(3):195-9.
  9. Gong J, Mohr G, Vézina JL. Endoscopic pituitary surgery with and without image guidance: an experimental comparison. Surgical neurology. 2007 Jun 1; 67(6):572-8.
  10. Cavallo LM, Cappabianca P, Galzio R, Iaconetta G, de Divitiis E, Tschabitscher M. Endoscopic transnasal approach to the cavernous sinus versus transcranial route: anatomic study. Operative Neurosurgery. 2005 Apr 1; 56(suppl_4): ONS-379.
  11. Aydin S, Cavallo LM, Messina A, Dal Fabbro M, Cappabianca P, Barlas O, De Divitiis E, Calbucci F. The endoscopic endonasal trans-sphenoidal approach to the sellar and suprasellar area: Anatomic study/ Comment. Journal of neurosurgical sciences. 2007 Sep 1; 51(3):129.
  12. Herzallah IR, Casiano RR. Endoscopic endonasal study of the internal carotid artery course and variations. American journal of rhinology. 2007 May; 21(3):262-70.
  13. Bassim MK, Senior BA. Endoscopic anatomy of the parasellar region. American journal of rhinology. 2007 Jan; 21(1):27-31.
  14. de Notaris M, Esposito I, Cavallo LM, Burgaya AC, Galino AP, Esposito F, Poblete JM, Ferrer E, Cappabianca P. Endoscopic endonasal approach to the ethmoidal planum: anatomic study. Neurosurgical review. 2008 Jul; 31(3):309-17.
  15. Tan HK, Ong YK. Sphenoid sinus: an anatomic and endoscopic study in Asian cadavers. Clinical Anatomy: The Official Journal of the American Association of Clinical Anatomists and the British Association of Clinical Anatomists. 2007 Oct; 20(7): 745-50.
  16. Cavallo LM, de Divitiis O, Aydin S, Messina A, Esposito F, Iaconetta G, Talat K, Cappabianca P, Tschabitscher M. Extended endoscopic endonasal transsphenoidal approach to the suprasellar area: anatomic considerations—part 1. Operative Neurosurgery. 2007 Sep 1; 61(suppl_3): ONS-24.
  17. Štoković N, Trkulja V, Dumić-Čule I, Čuković-Bagić I, Lauc T, Vukičević S, Grgurević L. Sphenoid sinus types, dimensions and relationship with surrounding structures. Annals of Anatomy-Anatomischer Anzeiger. 2016 Jan 1; 203:69-76.
  18. El-Banhawy OA, El-Dien AE, Zolfakar AS, Halaka AN, Ayad H. Endoscopic endonasal partial middle turbinectomy approach: adaptability of the procedure in a cadaveric study and in surgery for different sphenoid sinus and skull base lesions. Skull Base. 2006 Nov; 16(01):001-13.
  19. Magro F, Solari D, Cavallo LM, Samii A, Cappabianca P, Paternò V, Lüdemann WO, Divitiis ED, Samii M. The endoscopic endonasal approach to the lateral recess of the sphenoid sinus via the pterygopalatine fossa: comparison of endoscopic and radiological landmarks. Operative Neurosurgery. 2006 Jan; 59 (suppl_4): ONS-237.
  20. Casler JD, Doolittle AM, Mair EA. Endoscopic surgery of the anterior skull base. The Laryngoscope. 2005 Jan; 115(1):16-24.
  21. Batay F, Vural E, Karasu A, Al-Mefty O. Comparison of the exposure obtained by endoscope and microscope in the extended trans-sphenoidal approach. Skull Base. 2002; 12(03):119-24.
  22. Jho HD, Ha HG. Endoscopic endonasal skull base surgery: Part 2-The cavernous sinus. min-Minimally Invasive Neurosurgery. 2004 Feb; 47(01): 9-15.
  23. Jho HD, Ha HG. Endoscopic endonasal skull base surgery: Part 3-The clivus and posterior fossa. min- Minimally Invasive Neurosurgery. 2004 Feb; 47(01): 16-23.
  24. Kim HU, Kim SS, Kang SS, Chung IH, Lee JG, Yoon JH. Surgical anatomy of the natural ostium of the sphenoid sinus. The Laryngoscope. 2001 Sep; 111(9): 1599-602. Anusha B, Baharudin A, Philip R, Harvinder S,
  25. Shaffie BM. Anatomical variations of the sphenoid sinus and its adjacent structures: a review of existing literature. Surgical and Radiologic Anatomy. 2014 Jul 1; 36(5):419-27.
  1. Budu V, Mogoanta CA, Fanuta B, Bulescu I. The anatomical relations of the sphenoid sinus and their implications in sphenoid endoscopic surgery. Rom J Morphol Embryol. 2013 Jan 1; 54(1):13-6.
  2. Fujii K, Chambers SM, Rhoton AL. Neurovascular relationships of the sphenoid sinus: a microsurgical study. Journal of neurosurgery. 1979 Jan 1; 50(1):31-9.

 

 

 

 

 

Iranian Journal of Otorhinolaryngology
Volume 33, Issue 4
July and August 2021
Pages 237-242

Files

Share

How to cite

Statistics