scholarly journals Variability of the Anterior Ethmoid Artery in Endoscopic Sinus Surgery

2020 ◽  
pp. 014556132095048
Author(s):  
Mohamed A. Taha ◽  
Christian A. Hall ◽  
Harry E. Zylicz ◽  
Margaret B. Westbrook ◽  
William T. Barham ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Skull Base ◽  
Statistical Significance ◽  
Sinus Surgery ◽  
Preoperative Imaging ◽  
Computed Tomography Scans ◽  
Ethmoidal Artery ◽  
Anterior Ethmoidal Artery ◽  
The Right ◽  
Anterior Ethmoid Artery

Introduction: The anterior ethmoidal artery (AEA) demonstrates anatomic variability relative to its descent from the anterior skull base. Our study’s objective was to assess for correlation of AEA descent and laterality, in addition to correlation of AEA descent and the presence of supraorbital ethmoid cells (SOEC) and concha bullosae (CB). Method: A retrospective study was performed at a tertiary rhinology center from January 2019 to January 2020. Noncontrast maxillofacial computed tomography scans were examined independently by 2 fellowship trained rhinologists. The vertical distance from both left and right AEAs to the ipsilateral skull base were compared and correlated with the presence of ipsilateral SOEC and CB. Results: Computed tomography scans from 50 subjects were included. Mean age was 50.68 years (40% females). The distance of AEA to the skull base was greater on the left when compared to the right (62% vs 48%) ( P < .05). The left AEA had an average descent of 2.84 mm versus 1.78 mm on the right ( P < .05). An SOEC was present in 56% of cases. Thirty-eight percent of subjects had both SOEC and AEA descent on the right, while 52% of subjects had both on the left. This reached a statistical significance on both sides ( P < .05). Concha bullosa was present in 35% of cases, with both AEA descent and CB present in 16% on the right, and 32% on the left. Conclusion: The AEA displays variability in vertical descent from the skull base, with greater variability on the left. These findings implore vigilance with evaluation of preoperative imaging and during sinus surgery, especially in the presence of SOEC and CB.

Radiological anatomy of the anterior ethmoidal artery for functional endoscopic sinus surgery

2007 ◽  
Vol 122 (3) ◽  
pp. 264-267 ◽  
Author(s):  
S E McDonald ◽  
P J Robinson ◽  
D A Nunez
Keyword(s):  
Computed Tomography ◽  
Skull Base ◽  
Sinus Surgery ◽  
Radiological Anatomy ◽  
Base Level ◽  
Computed Tomography Scans ◽  
Ethmoidal Artery ◽  
Anterior Ethmoidal Artery ◽  
Ethmoidal Foramen ◽  
Anterior Ethmoidal Foramen

AbstractAim:This study investigated the extent to which the anterior ethmoidal artery and anterior ethmoidal foramen could be reliably identified on routine coronal sinus computed tomography scans. Where they could be identified, the relationship of these structures with the vertical height of the skull base, and their distance from an anterior landmark, were measured.Methods:Fifty consecutive coronal sinus computed tomography scans were viewed independently by two observers. Scans were reviewed when the observers' opinions differed.Results:Inter-observer concordance was high. The anterior ethmoidal foramen was visualised in 95 per cent of cases bilaterally and in the remaining 5 per cent unilaterally. The anterior ethmoidal artery was visualised in 33 per cent of scans. The anterior ethmoidal foramen was at skull base level in 72 per cent of sides studied, and below it in the remainder. The distance from the lacrimal crest to the anterior ethmoidal foramen was 22.4 mm (mean; standard deviation 3.7).Conclusion:The anterior ethmoidal foramen is a reliable landmark on coronal computed tomography scans of the paranasal sinuses. From this, the position of the anterior ethmoidal artery can be inferred.

An artificial intelligence algorithm that differentiates anterior ethmoidal artery location on sinus computed tomography scans

2019 ◽  
Vol 134 (1) ◽  
pp. 52-55 ◽  
Author(s):  
J Huang ◽  
A-R Habib ◽  
D Mendis ◽  
J Chong ◽  
M Smith ◽  
...  
Keyword(s):  
Neural Network ◽  
Artificial Intelligence ◽  
Computed Tomography ◽  
Neural Networks ◽  
Convolutional Neural Network ◽  
Convolutional Neural Networks ◽  
Sinus Surgery ◽  
Computed Tomography Scans ◽  
Ethmoidal Artery ◽  
Anterior Ethmoidal Artery

AbstractObjectiveDeep learning using convolutional neural networks represents a form of artificial intelligence where computers recognise patterns and make predictions based upon provided datasets. This study aimed to determine if a convolutional neural network could be trained to differentiate the location of the anterior ethmoidal artery as either adhered to the skull base or within a bone ‘mesentery’ on sinus computed tomography scans.MethodsCoronal sinus computed tomography scans were reviewed by two otolaryngology residents for anterior ethmoidal artery location and used as data for the Google Inception-V3 convolutional neural network base. The classification layer of Inception-V3 was retrained in Python (programming language software) using a transfer learning method to interpret the computed tomography images.ResultsA total of 675 images from 388 patients were used to train the convolutional neural network. A further 197 unique images were used to test the algorithm; this yielded a total accuracy of 82.7 per cent (95 per cent confidence interval = 77.7–87.8), kappa statistic of 0.62 and area under the curve of 0.86.ConclusionConvolutional neural networks demonstrate promise in identifying clinically important structures in functional endoscopic sinus surgery, such as anterior ethmoidal artery location on pre-operative sinus computed tomography.

Don't sue the surgeon: remineralisation of the skull base or a defect that never existed?

2011 ◽  
Vol 125 (12) ◽  
pp. 1294-1297
Author(s):  
C Hopkins ◽  
S Dhillon ◽  
G Rogers ◽  
D Roberts
Keyword(s):  
Computed Tomography ◽  
Skull Base ◽  
Endoscopic Sinus Surgery ◽  
Semicircular Canals ◽  
Time Frame ◽  
Sinus Surgery ◽  
Operative Exploration ◽  
Intracranial Complications ◽  
Operative Findings ◽  
The Right

AbstractIntroduction:Intracranial complications are recognised as rare, but serious, sequelae of endoscopic sinus surgery.Case report:A 56-year-old woman was referred after developing meningitis following elective functional endoscopic sinus surgery. Computed tomography demonstrated a significant defect of the skull base in the right posterior ethmoid, clearly visible on both coronal and sagittal sections. Operative exploration demonstrated the skull base to be intact in the posterior ethmoid area identified on the scan, and the overlying mucosa appeared undisturbed. Scans were reviewed in the light of operative findings; coronal and sagittal images were found to be reconstructions. Directly acquired coronal computed tomography, undertaken three weeks after surgery, demonstrated a complete bony plate in the right posterior ethmoid at the site previously identified as dehiscent.Discussion and conclusion:We speculate that the posterior ethmoid defect was actually an artefact of reconstruction. We cannot exclude the alternative possibility of remineralisation, but given the time frame this seems unlikely. This case highlights the need for caution when interpreting reconstructed images of the thin bony plates of the skull base and lamina papyracea, as regards both clinical significance and medicolegal reporting. While virtual defects have been reported in the superior semicircular canals as a result of reconstructed images, we believe this to be the first reported case demonstrating a similar problem in the anterior skull base.

scholarly journals Study of variants of anterior ethmoidal artery on computed tomography of paranasal sinuses

2018 ◽  
Vol 5 (1) ◽  
pp. 19
Author(s):  
S. B. Amarnath ◽  
P. Suresh Kumar
Keyword(s):  
Computed Tomography ◽  
Skull Base ◽  
Paranasal Sinuses ◽  
Congenital Anomalies ◽  
Anatomical Landmark ◽  
Frontal Recess ◽  
Severe Epistaxis ◽  
History Of ◽  
Ethmoidal Artery ◽  
Anterior Ethmoidal Artery

<p class="abstract"><strong>Background:</strong> The anterior ethmoidal artery (AEA) is an anatomical landmark, its position is important for recognizing structures of difficult access (frontal sinus) and to define skull base in surgery.Additionally, visualizing this artery makes it possible to identify and treat causes of severe epistaxis. The aims and objectives of the study were to determine the reliability of identification of the AEA on the coronal CT scan, to study the variability in the pneumatisation of the suprabullar recess and the course of the AEA and to determine whether a correlation exists between the pneumatisation of the suprabullar recess and the distance of the AEA from the base skull.</p><p class="abstract"><strong>Methods:</strong> This study conducted among 200 Patients attending to ENT OPD, Yashoda hospital, Secunderabad with history of headache, nose block who underwent CT-PNS. Patients with age above 18 years without any congenital anomalies of face, without opacification in frontal recess or anterior ethmoidal cells, without nasal surgeries or trauma were included in the present study. All the 200 CT-PNS were studied in detail by using PACS and DICOM software.  </p><p class="abstract"><strong>Results:</strong> In this study AEA was present in 100% of cases on both sides. In this study AEA was seen in skull base in 50.75% of cases, among this 51% was on right side, remaining was on left side.</p><p class="abstract"><strong>Conclusions:</strong> CT-PNS coronal sections are helpful in assessment of AEA position pre-operatively. AEF and AES act as important landmarks for the identification of AEA in CT-PNS.</p>

Anterior Ethmoidal Artery: A Computed Tomography Analysis and New Classifications

2020 ◽  
Author(s):  
Mohammad Waheed El-Anwar ◽  
Alaa Omar Khazbak ◽  
Diaa Bakry Eldib ◽  
Hesham Youssef Algazzar
Keyword(s):  
Computed Tomography ◽  
Skull Base ◽  
Frontal Sinus ◽  
Ethmoidal Artery ◽  
Anterior Ethmoidal Artery ◽  
The Mean ◽  
Type 3 ◽  
Sinus Ostium

Abstract Objective to determine the anterior ethmoidal artery (AEA) anatomy and variations by computed tomography (CT) in adult and their relations to and presents new AEA classifications. Methods One hundred and fifty paranasal CT scans (300 sides) were included. Axial images were acquired with multiplanar reformates to obtain delicate details in coronal and sagittal planes. Results One hundred and forty-four AEAs canal (48%), 293 AEAs foramen (97.7%), and 229 AEAs sulcus could be detected (76.3%). The mean AEA intranasal length was 6.7 ± 1.27 mm (range: 4.24–10.6 mm). The mean angle between AEA and lamina papyracea was 105.49 ± 9.28 degrees (range: 76.41–129.76 degrees). Of them, 95.8% AEAs had an angle with lamina >90 degrees, while 4.2% had angle <90 degrees. The mean angle between AEA and lateral lamella of cribriform plate was 103.95 ± 13.08 degrees (range: 65.57–141.36 degrees). Of them, 87.5% AEAs had an angle >90 degrees and 12.5% had an angle <90 degrees. The mean distance between AEA and skull base was 1.37 ± 1.98 mm (range: 0–8.35 mm). The AEA types in relation to skull base was type 1 (0–2 mm from skull base; 64.6%), type 2 (2–4 mm; 22.2%), type 3 (4–6 mm; 11.1%), and type 4 (>6 mm; 2.1%). The mean distance between the AEA and frontal sinus ostium was 9.17 ± 4.72 mm (range: 0–25.36 mm). AEA classification according to distance from AEA to frontal sinus ostium was 17.4% type 1 (<5 mm), 41.7% type 2 (5–10 mm), 31.9% type 3 (10–15 mm), and 9% type 4 (>15 mm). Conclusion Provided AEA details improve surgeons' awareness of AEA variations in the endoscopic field and can help residents in training.

scholarly journals Computed tomography assessment of anterior ethmoidal canal dehiscence: An interobserver agreement study and review of the literature

2020 ◽  
Vol 33 (2) ◽  
pp. 145-151 ◽  
Author(s):  
Angela Guarnizo ◽  
Thanh B Nguyen ◽  
Rafael Glikstein ◽  
Nader Zakhari
Keyword(s):  
Computed Tomography ◽  
Interobserver Agreement ◽  
Descriptive Analysis ◽  
Sinus Surgery ◽  
Ct Scans ◽  
Ethmoidal Artery ◽  
Anterior Ethmoidal Artery ◽  
Agreement Study ◽  
Air Cells ◽  
Routine Assessment

Purpose The anterior ethmoidal artery can be injured in functional endoscopic sinus surgery. The ability of computed tomography (CT) to identify dehiscence of the anterior ethmoidal canal (AEC) has not been widely evaluated. The aim of this study was to evaluate the interobserver agreement in the CT assessment of AEC dehiscence. Methods We conducted a retrospective review of consecutive CT scans of the paranasal sinuses (PNS) between January 1, 2012, and December 31, 2012. Two neuroradiologists separately assessed the presence of AEC dehiscence, the presence of PNS opacification, and the best CT plane to evaluate the AEC. Statistical analysis included descriptive analysis and interobserver agreement (kappa coefficient). Results The AEC was below the skull base in 199 (22.3%) cases. Dehiscence of the AEC was found in 13.2% for reader 1 and in 7.3% for reader 2. The interobserver agreement for identification of AEC dehiscence was only fair (κ = 0.246). The interobserver agreement for the AEC dehiscence in cases with opacification of ethmoidal air cells was substantial (κ = 0.754). Conclusion The suboptimal interobserver agreement could potentially limit the usefulness of CT scans for routine assessment of AEC dehiscence. In patients with PNS opacification, CT scans could still add valuable information regarding AEC dehiscence.

International Frontal Sinus Anatomy Classification and Anatomic Predictors of Low-Lying Anterior Ethmoidal Arteries

2017 ◽  
Vol 31 (3) ◽  
pp. 174-176 ◽  
Author(s):  
Phayvanh P. Sjogren ◽  
Rajendra Waghela ◽  
Shaelene Ashby ◽  
Richard H. Wiggins ◽  
Richard R. Orlandi ◽  
...  
Keyword(s):  
Skull Base ◽  
Effect Size ◽  
Frontal Sinus ◽  
Pearson Correlation ◽  
Correlation Coefficients ◽  
Anterior Wall ◽  
Sinus Surgery ◽  
Type I ◽  
Ethmoidal Artery ◽  
Anterior Ethmoidal Artery

Background The International Frontal Sinus Anatomy Classification (IFAC) was introduced to more accurately characterize ethmoid and frontal sinus pneumatization patterns. The prevalence of IFAC cells and their anatomic associations have not been described. Objective The goal was to examine the prevalence of IFAC cells and determine radiologic features associated with a low-lying anterior ethmoidal artery (LAEA). Methods Imaging of adult patients who underwent computed tomographies from January 2015 to March 2016 were retrospectively reviewed by using the IFAC classification. We also measured the distance from the skull base to the anterior ethmoidal artery (AEA), the height of the lateral lamella of the cribriform plate, and anterior-posterior diameter from the anterior wall of the frontal sinus to the skull base (APF). Patients with a history of sinus surgery, trauma, malignancy, or congenital anomaly were excluded. Statistical analysis was performed by using Pearson correlation coefficients and χ2 tests. Results A total of 95 patients met the inclusion criteria. There was a significant association between supraorbital ethmoid cells and an LAEA (p < 0.001), with a significant effect size (ϕ = 0.276, p = 0.007). An inverse relationship was observed between Keros type I classification I and an LAEA (p < 0.001), with a significant effect size (ϕ = -0.414, p = 0.000). Significant associations were found between the AEA distance from the skull base and the cribriform lateral lamella height (R = 0.576, p < 0.001). In addition, there was a significant association between the AEA distance from the skull base and the APF (R = 0.497, p < 0.001). Conclusion The presence of a supraorbital ethmoid cell and a wide APF were associated with an LAEA. There was a significant relationship between Keros type I classification and the AEA adjacent to the skull base. Delineation of these anatomic relationships may be helpful during endoscopic sinus surgery to avoid complications.

scholarly journals A systematic approach to the interpretation of computed tomography scans prior to endoscopic sinus surgery

1998 ◽  
Vol 112 (10) ◽  
pp. 986-990 ◽  
Author(s):  
J. D. T. Mason ◽  
N. S. Jones ◽  
R. J. Hughes ◽  
I. M. Holland
Keyword(s):  
Computed Tomography ◽  
Skull Base ◽  
Structural Changes ◽  
Systematic Approach ◽  
Sinus Surgery ◽  
Bony Destruction ◽  
Increased Risk ◽  
Computed Tomography Scans ◽  
Onodi Cell ◽  
Extent Of Disease

AbstractComputed tomography (CT) provides an excellent map for the sinus surgeon aswell as providing information about the extent of disease and the presence of bony destruction. Surgeons need to be aware of the anatomical configuration of the sinuses and the presence of any structural changes such as a dehiscent lamina papyracea, asymmetric skull base, low level of posterior skull base or an Onodi cell, which place the patient at increased risk. Described here is a six-step guide to help the sinus surgeon avoid missing any of the radiologically important features.

scholarly journals Anterior Ethmoidal Artery Emerging Anterior to Bulla Ethmoidalis: An Abnormal Anatomical Variation in Waardenburg's Syndrome

2014 ◽  
Vol 5 (3) ◽  
pp. ar.2014.5.0094 ◽  
Author(s):  
Danny K. C. Wong ◽  
Angus Shao ◽  
Raewyn Campbell ◽  
Richard Douglas
Keyword(s):  
Anatomical Variation ◽  
Vascular Anatomy ◽  
Sinus Surgery ◽  
Facial Features ◽  
Retrobulbar Hematoma ◽  
Ethmoidal Artery ◽  
Anterior Ethmoidal Artery ◽  
Craniofacial Features ◽  
The Right ◽  
Tomography Scan

In endoscopic sinus surgery, the anterior ethmoidal artery (AEA) is usually identified as it traverses obliquely across the fovea ethmoidalis, posterior to the bulla ethmoidalis and anterior to or within the ground lamella's attachment to the skull base. Injury to the AEA may result in hemorrhage, retraction of the AEA into the orbit, and a retrobulbar hematoma. The resulting increase in intraorbital pressure may threaten vision. Waardenburg's syndrome (WS) is a rare congenital, autosomal dominantly inherited disorder, distinguished by characteristic facial features, pigmentation abnormalities, and profound, congenital, sensorineural hearing loss. We present a case of AEAs located anterior to the bulla ethmoidalis in a 36-year-old male with WS and chronic rhinosinusitis. The anatomic abnormality was not obvious on a preoperative computed tomography scan and was discovered intraoperatively when the left AEA was injured, resulting in a retrobulbar hematoma. The hematoma was immediately identified and decompressed endoscopically without lasting complications. The AEA on the right was identified intraoperatively and preserved. The characteristic craniofacial features in WS were probably associated with the abnormal vascular anatomy. Endoscopic sinus surgeons should be aware of these potential anatomic anomalies in patients with abnormal craniofacial development.

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