Endoscopic Localization of the Anterior and Posterior Ethmoid Arteries

2008 ◽  
Vol 117 (12) ◽  
pp. 931-935 ◽  
Author(s):  
Joseph K. Han ◽  
Samuel S. Becker ◽  
Steven R. Bomeli ◽  
Charles W. Gross
Keyword(s):  
Skull Base ◽  
Sphenoid Sinus ◽  
Image Guidance ◽  
Middle Turbinate ◽  
Anterior Wall ◽  
Guidance System ◽  
External Incision ◽  
The Mean ◽  
Endoscopic Localization ◽  
Anterior Ethmoid Artery

Objectives: Understanding the endoscopic locations of the anterior and posterior ethmoid arteries is important during endoscopic sinus or endoscopic skull base procedures so that these arteries can be avoided. Therefore, the objective of this study was to define the endoscopic locations of the ethmoid arteries. Methods: Twenty-four cadaver heads were used to identify the endoscopic location of the ethmoid arteries via an external incision. An image guidance system was used to record the locations of these arteries. The anterior ethmoid artery was referenced to the axilla of the middle turbinate, and the posterior ethmoid artery to the anterior wall of the sphenoid sinus. The closest lamella to these arteries was identified. Results: Forty-eight nasal cavities were dissected. The mean distance from the axilla to the anterior ethmoid artery was 17.5 mm. The anterior ethmoid artery was located immediately anterior to (31%), at (36%), or immediately posterior to (33%) the superior attachment of the basal lamella. The mean distance from the posterior ethmoid artery to the anterior ethmoid artery was 14.9 mm. The mean distance from the posterior ethmoid artery to the anterior wall of the sphenoid sinus was 8.1 mm. The posterior ethmoid artery was either anterior to (98%) or at (2%) the anterior face of the sphenoid sinus. Conclusions: Specific endoscopic anatomic relationships and measurements have been presented for the anterior and posterior ethmoid arteries.

In vivo accuracy of image guidance performed using optical tracking and optimized registration

2006 ◽  
Vol 105 (4) ◽  
pp. 561-567 ◽  
Author(s):  
Christopher R. Mascott
Keyword(s):  
Image Guidance ◽  
Optical Tracking ◽  
Guidance System ◽  
Imaging Data ◽  
Mr Images ◽  
Common Error ◽  
Depth Electrodes ◽  
The Mean ◽  
The Difference

Object Image guidance systems involving the use of frameless referencing of surgical space to compile volumetric imaging data sets recently have come into widespread use. Few studies have addressed the true intraoperative surgical accuracy (that is, the application accuracy) of these systems except in a subjective manner. Calculated accuracies given by the systems do not necessarily reflect true intraoperative accuracy. Methods To objectively assess the stereotactic accuracy of a frameless image guidance system using optical spatial referencing, the author analyzed postoperative magnetic resonance (MR) images after placement of depth electrodes for the investigation of epilepsy. Preoperative planning for the treatment of seven patients included implanting skull fiducial screws and obtaining computed tomography/MR fusion images by using ImMerge image fusion software on the StealthStation (Medtronic, Inc.). A total of 42 electrodes were placed. Postoperative volumetric MR images were fused with preoperative study images. The difference between the planned electrode trajectories and targets and the visualized electrodes was measured in stereotactic space. Conclusions The mean distance between the distal electrode contact and the distal end of the planned trajectory for the 42 targets was 3 ± 1.5 mm. The most common error was in depth. The author’s technique did not involve rigid skull fixation of electrodes because they were subsequently tunneled subcutaneously and later removed at the bedside of the patient. Errors in depth were known to be due to traction at the time of tunneling and not due to stereotactic factors. Correcting for depth along the electrode trajectory, the mean accuracy was found to be 2.4 ± 1 mm.

Reconstruction of the Anterior Wall of the Sphenoid Sinus with a Composite Osteomucosal Middle Turbinate Pedicled Flap

2014 ◽  
Vol 75 (S 01) ◽  
Author(s):  
Mark Toma ◽  
Robert Engle ◽  
Maria Peris-Celda ◽  
Tyler Kenning ◽  
Carlos Pinheiro-Neto
Keyword(s):  
Sphenoid Sinus ◽  
Middle Turbinate ◽  
Anterior Wall ◽  
Pedicled Flap

Using the Middle Turbinate to Protect the Skull Base in Endoscopic Transsphenoidal Surgery: A Cadaver Study

2020 ◽  
Vol 35 (1) ◽  
pp. 59-63
Author(s):  
Janki Shah ◽  
Dennis Tang ◽  
Kevin Grafmiller ◽  
Zachary J. Cappello ◽  
Christopher Roxbury ◽  
...  
Keyword(s):  
Skull Base ◽  
Sphenoid Sinus ◽  
Contact Point ◽  
Middle Turbinate ◽  
Cadaver Study ◽  
Neutral Position ◽  
Intracranial Injury ◽  
Increased Risk ◽  
Human Cadavers ◽  
First Contact

Objectives Inadvertent intracranial injury from nasogastric tube (NGT) placement is a described and potentially fatal complication following endoscopic transsphenoidal hypophysectomy (TSH). This cadaver study assessed the role of middle turbinate (MT) preservation and medialization in preventing accidental skull base injury from NGT insertion after TSH. Methods: Standard approach for TSH was performed on 3 human cadavers. MTs were placed into neutral position (MTN), then medialized via suture pexy to the septum (MTP), and subsequently resected (MTR). After each stage, 3 blinded individuals passed a 10 F Dobhoff and a 16 F NGT on each side of each cadaver (5 passes per side). Using endoscopic visualization, each pass was scored by a blinded reviewer based on the first contact point of the tube (0 = nasopharynx, 1 = inferior sphenoid face, 2 = sphenoid sinus), with higher scores suggestive of increased risk of intracranial injury. Results: There were 270 Dobhoff and 270 NGT passes scored. Data was divided into 3 groups based on presence and position of the MT. Significant differences were demonstrated between all three groups [one-way ANOVA: Dobhoff F(2,267) = 6.981, p = 0.001], [NGT F(2,267) = 17.582, p < 0.001]. There were significant differences between means for MTN versus MTP groups [Dobhoff (0.43 vs 0.22, p = 0.007), NGT (0.73 vs 0.28, p < 0.001)] and MTP versus MTR groups [Dobhoff (0.22 vs 0.55, p < 0.001), NGT (0.28 vs 0.81, p < 0.001)], indicating that the presence and position of the MT can significantly affect the accessibility of the sphenoid sinus interior after TSH. There was a trend toward lower means in the MTN group compared to the MTR group. Conclusion: MT preservation and deliberate medialization against the septum may reduce risk of inadvertent intracranial NGT injury in postop TSH patients. This simple maneuver should be considered in all routine TSH procedures.

scholarly journals Contralateral transmaxillary corridor: an augmented endoscopic approach to the petrous apex

2018 ◽  
Vol 129 (1) ◽  
pp. 211-219 ◽  
Author(s):  
Chirag R. Patel ◽  
Eric W. Wang ◽  
Juan C. Fernandez-Miranda ◽  
Paul A. Gardner ◽  
Carl H. Snyderman
Keyword(s):  
Sphenoid Sinus ◽  
Image Guidance ◽  
Internal Carotid ◽  
Effective Means ◽  
Anterior Wall ◽  
Petrous Apex ◽  
Total Resection ◽  
Endoscopic Endonasal ◽  
Medial Maxillectomy ◽  
Clinical Cases

OBJECTIVEThe endoscopic endonasal approach (EEA) has been shown to be an effective means of accessing lesions of the petrous apex. Lesions that are lateral to the paraclival segment of the internal carotid artery (ICA) require lateralization of the paraclival segment of the ICA or a transpterygoid infrapetrous approach. In this study the authors studied the feasibility of adding a contralateral transmaxillary (CTM) corridor to provide greater access to the petrous apex with decreased need for manipulation of the ICA.METHODSUsing image guidance, EEA and CTM extension were performed bilaterally on 5 cadavers. The anterior wall of the sphenoid sinus and rostrum were removed. The angle of the surgical approach from the axis of the petrous segment of the ICA was measured. Five illustrative clinical cases are presented.RESULTSThe CTM corridor required a partial medial maxillectomy. When measured from the axis of the petrous ICA, the CTM corridor decreased the angle from 44.8° ± 2.78° to 20.1° ± 4.31°, a decrease of 24.7° ± 2.58°. Drilling through the CTM corridor allowed the drill to reach lateral aspects of the petrous apex that would have required lateralization of the ICA or would not have been accessible via EEA. The CTM corridor allowed us to achieve gross-total resection of the petrous apex region in 5 clinical cases with significant paraclival extension.CONCLUSIONSThe CTM corridor is a feasible extension to the standard EEA to the petrous apex that offers a more lateral trajectory with improved access. This approach may reduce the risk and morbidity associated with manipulation of the paraclival ICA.

Intranasal location of lacrimal sac in Thai cadavers

2010 ◽  
Vol 4 (2) ◽  
pp. 323-327
Author(s):  
Napas Tanamai ◽  
Teeraporn Ratanaanekchai ◽  
Sanguansak Thanaviratananich ◽  
Kowit Chaisiwamongkol ◽  
Thanarat Chantaumpalee
Keyword(s):  
Middle Turbinate ◽  
Anterior Wall ◽  
Posterior Border ◽  
Lacrimal Sac ◽  
Endoscopic Dacryocystorhinostomy ◽  
Exact Boundary ◽  
Khon Kaen ◽  
The Mean

Abstract Background: Many current literatures have described that the lacrimal sac is located just anterior to the anterior attachment (axilla) of the middle turbinate. However, there was no data on the exact boundary of the sac, especially the distance related with a permanent landmark such as the middle turbinate attachment. Objective: Determine the intranasal location of the lacrimal sac related to the middle turbinate attachment in Thai fresh cadavers. Methods: The study was performed in 26 Thai fresh cadavers, donated to Khon Kaen University, Thailand between July 2006 and July 2007. The height and width of the lacrimal sac were recorded, as well as the distances from the upper, lower, anterior and posterior border of the lacrimal sac to the axilla of the middle turbinate were measured. Results: The mean height and width of 52 lacrimal sacs were 11.2 and 6.2 mm. The mean distances from the upper, lower, anterior, and posterior border of lacrimal sac to the axilla of the middle turbinate were 4.9 mm (95%CI=4.4-5.4), 5.6 mm (95%CI=5.1-6.1), 3 mm (95%CI=2.4-3.6), and 2.9 mm (95%CI=2.3-3.5), respectively. The upper border of all lacrimal sacs were located superior to the axilla of the middle turbinate (95%CI=93.1-100), and posterior border of 44 sacs (85%, 95%CI=72.5-92.0) were located posterior to the axilla. Additionally, the anterior wall did not extend anterior to the anterior attachment of the middle turbinate in 21% of the sac. Conclusion: This study revealed the more exact intranasal location of lacrimal sacs. This is useful for surgeons to perform adequate endoscopic dacryocystorhinostomy to prevent postoperative lacrimal sump syndrome.

Image-Guided Resection of Fibro-Osseous Lesions of the Skull Base

2003 ◽  
Vol 17 (2) ◽  
pp. 115-118 ◽  
Author(s):  
Mark Samaha ◽  
Ralph Metson
Keyword(s):  
Skull Base ◽  
Optic Neuropathy ◽  
Facial Pain ◽  
High Speed ◽  
Image Guidance ◽  
Bone Growth ◽  
Intraoperative Complications ◽  
Guidance System ◽  
Bone Removal ◽  
Additional Surgery

Background Endoscopic resection of sinonasal fibro-osseous lesions remains a technical challenge because of the loss of anatomic landmarks and the frequent need to resect bone along the skull base. The purpose of this study was to evaluate the usefulness of image-guidance systems for the resection of these lesions. Methods Endoscopic surgery was performed in 10 patients with fibro-osseous lesions of the sinuses and skull base (six fibrous dysplasias and four osteomas). Indications for surgical intervention were recurrent infection (7), facial pain (3), mucocele (1), and compressive optic neuropathy (1). All surgeries were performed with an image-guidance system, which included an integrated high-speed drill system. Results Anatomic localization was accurate to within 1 mm when monitoring the depth of bone removal along the skull base. Complete resection of the fibro-osseous lesion was possible in six patients (60%) and partial removal was possible in four patients (40%). In the latter group, a margin of dysplastic bone was preserved along the ethmoid roof to prevent dural exposure. There were no intraoperative complications. Surgery resulted in resolution of infection and facial pain in nine patients (90%). Additional surgery was required in one patient (10%) who developed recurrent optic neuropathy because of continued dysplastic bone growth. Mean follow-up was 34 months (range, 13–67 months). Conclusion Image-guidance technology appears to be ideally suited for the treatment of patients with fibro-osseous lesions of the sinonasal cavity. Real-time monitoring of the depth of bone removal relative to the skull base may enhance the safety and efficacy of such surgery.

scholarly journals 351 Anterior Ethmoid Artery Septal Flap for Endoscopic Reconstruction of Frontal Sinus CSF Leak

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
G Adegboyega ◽  
H A Elhassan ◽  
J Zocchi ◽  
A Lambertoni ◽  
G Bozkurt ◽  
...  
Keyword(s):  
Skull Base ◽  
Frontal Sinus ◽  
Middle Turbinate ◽  
Posterior Wall ◽  
Csf Leak ◽  
Csf Rhinorrhea ◽  
Endoscopic Closure ◽  
Nasal Floor ◽  
Anterior Ethmoid Artery ◽  
Csf Leaks

Abstract Introduction Anterior skull base cerebrospinal fluid (CSF) leaks are managed successfully with endonasal surgery. Endoscopic closure of CSF leaks from posterior table of the frontal sinus remains challenging. Vascularized Hadad-Bassagasteguy flap (HBF) reconstruction of the skull base has increased CSF closure rates but does not extend to frontal sinus. We describe our technique using septal flap pedicled by anterior ethmoid artery (AEA) for repairing frontal defects. Method Retrospective review of cases of frontal CSF leak repair using the AEA flap reconstruction. Flap design: an anterior vertical septal mucosa incision at posterior border of the frontal sinusotomy is made and extended to nasal floor. Posterior vertical incision is made 1 cm posterior to the projection of the axilla of the middle turbinate on the septum and extended to nasal floor. A horizontal incision along the nasal floor joins the two incisions. The flap is raised and rotated into the frontal sinus over the posterior table reconstructed defect. Results Three patients identified. Two males, one female, aged 11, 33 and 56. Patient histories included recurrent bacterial meningitis following head trauma, recurrent sinusitis and fronto-ethmoidal osteoma, with intraoperative CSF leak and CSF rhinorrhea due to meningoencephalocele. The three posterior wall defects were successfully repaired endoscopically with multilayer reconstruction and the AEA septal flap. Conclusions The anterior ethmoid artery septal flap can be successfully utilised for frontal CSF leak repair. Flap is conveniently located for frontal sinus defects. When the septum is intact it provides an excellent final layer as part of multilayer reconstruction.

scholarly journals Anatomic Study of Endoscopic Transnasal Approach to Petrous Apex

2020 ◽  
Vol 218 ◽  
pp. 03016
Author(s):  
Wenyuan He ◽  
Qingying Qin ◽  
Guxian Wang
Keyword(s):  
Skull Base ◽  
Sphenoid Sinus ◽  
Lateral Wall ◽  
Anterior Wall ◽  
Surgical Anatomy ◽  
Petrous Apex ◽  
Transnasal Approach ◽  
Long Time ◽  
Endoscopic Transnasal Approach ◽  
Micro Drill

With the development of Neurosurgery technology, there has been a qualitative leap forward with the appearance of microanatomy, which makes the deep brain tumors which were hard to be achieved in the past, and effectively reduces the mortality of patients. Petrous apex is a cone-shaped part of the anteromedial part of the temporal bone, which is deep. It has been a challenging area for surgical anatomy for a long time. In this paper, fresh adult perfused cadaveric head specimens and dry adult cadaveric head specimens were taken as the experimental objects. The anterior wall of sphenoid sinus and the internal septum of sphenoid sinus were excised under neuroendoscope. The structures of the lateral wall of sphenoid sinus were identified and dissected. The lateral wall of sphenoid sinus and the bone of skull base were opened with micro drill, The meninges were exposed and cut open, and the related structures were dissected, observed and photographed. The experimental results show that it is relatively safe to operate in the range of less than 8mm, and the rock tip can be found accurately. The measurement of the bony structure of the skull base is helpful for the surgeon to judge the course of the internal carotid artery and its adjacent structure.

scholarly journals Spontaneous cerebrospinal fluid rhinorrhoea and its association with body mass index (BMI)

2019 ◽  
Vol 18 (2) ◽  
pp. 322-328 ◽  
Author(s):  
Tan Yee Wen ◽  
Balwant Singh Gendeh ◽  
Rohana Ali O’Connell Husain ◽  
Salina Husain ◽  
Kamalan Jeevaratnam
Keyword(s):  
Body Mass Index ◽  
Cerebrospinal Fluid ◽  
Body Mass ◽  
Sphenoid Sinus ◽  
Medical Science ◽  
Middle Turbinate ◽  
Surgical Techniques ◽  
Cerebrospinal Fluid Rhinorrhoea ◽  
National University ◽  
The Mean

Objective: The purpose of this study is to review the correlation of spontaneous cerebrospinal fluid rhinorrhoea (CSFR) and Body Mass Index (BMI) and describe the demographics, the surgical techniques and outcomes. Materials and methods: We performed a retrospective review of clinical data of twenty patients diagnosed with spontaneous CSFR and treated at the Malaysian National University Medical Centre from 1997 to 2015. Result and Discussion: A total of 20 patients were selected in this research (19 females,1male). The mean age was 45.5 years with nineteen females and one male patient. The mean BMI was 33.1kg/m2.Majority of patients with spontaneous leaks are females in their forties. The bath plug technique, onlay of middle turbinate grafts, nasoseptal flaps and mucoperiosteal grafts techniques were used and three patients reported recurrences. Conclusion: Spontaneous CSFR is more common in women in their 40s with BMI>25. The most common sites of leaks are the cribriform plate followed by the sphenoid sinus. Spontaneous CSFR cases are strongly related with increased BMI. Bangladesh Journal of Medical Science Vol.18(2) 2019 p.322-328

Speculum Opening in Transsphenoidal Surgery

2006 ◽  
Vol 59 (suppl_1) ◽  
pp. ONS-35-ONS-40 ◽  
Author(s):  
Adriano S. Garcia ◽  
Albert L. Rhoton
Keyword(s):  
Optic Nerve ◽  
Transsphenoidal Surgery ◽  
Sphenoid Sinus ◽  
Middle Turbinate ◽  
Anterior Wall ◽  
Contralateral Side ◽  
Orbital Apex ◽  
Optic Nerve Injury ◽  
Optic Nerves ◽  
The Face

Abstract OBJECTIVE: To assess the extent to which the transsphenoidal speculum can be safely opened at the face of and within the sphenoid sinus without risking damage to the optic nerves in the optic canals and at the orbital apex and the nerves coursing adjacent the walls of the sphenoid sinus. METHODS: The distance was measured between the optic nerves at the level of the anterior wall of the sphenoid sinus and 0.5 and 1.0 cm within the sinus. In addition, the distance between the middle turbinates and the contralateral optic canals was assessed because this turbinate is the largest structure blocking access to the sphenoid sinus in the transsphenoidal approach and tends to force the speculum away from the midline and toward the optic nerve in the contralateral side of the approach. RESULTS: Opening the transsphenoidal speculum at the anterior wall of the sphenoid sinus beyond 2.5 centimeters carries some risk of damaging the optic nerves and this distance narrows when the speculum opening is positioned inside the sphenoid sinus. Displacement of the speculum to one side by the middle turbinate places the speculum near the contralateral optic nerve and may be associated with optic nerve injury with lesser degrees of speculum opening. CONCLUSIONS: Careful attention should be directed to avoiding excessive opening of the transsphenoidal speculum at the anterior face of the sphenoid or within the sphenoid sinus.

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