Morphometric and Topographic Assessment of Foramen Ovale in Skulls of Jharkhand Population

Foramen ovale, situated in the greater wing of sphenoid, posterolateral to the foramen rotundum, transmits the sensory and motor root of mandibular nerve, accessory meningeal artery, emissary vein and lesser petrosal nerve to the infratemporal fossa. The normal shape of the foramen is oval, but its shape and size is quite variable. It plays an important role in the diagnostic and surgical procedures related to the middle cranial fossa. So, knowledge of the variations, dimensions and the topographic location is of importance to the neurosurgeons while dealing with surgeries in this region. Our study aims at finding the morphological variations in shape, dimensions of foramen ovale and its location in relation to the zygomatic arch.METHODSA cross-sectional observational study was carried out over a period of one year from 1/6/2018 to 31/5/2019, on 46 adult human skulls, taken from the department of Anatomy, RIMS, Ranchi. Fully dried, intact, adult human skulls were included in the study. Foramen ovale was observed for variation in shape, size and location. The presence of any accessory bony structure like bony plate, spine or septa was looked for and prevalence noted. The maximum antero-posterior length and width of foramen ovale and its distance from articular tubercle and the anterior root of zygomatic arch were measured using Vernier callipers. Pathologically malformed and damaged skulls were excluded from the study.RESULTSFour types of shapes were observed – oval (76.08%) , almond (5.43%) , semilunar (8.69%) and triangular (9.78%). The mean anteroposterior dimension of foramen ovale was 6.96 ± 1.17 mm (6.89 ± 1.28 mm on the right side & 7.02 ± 1.05 mm on the left side) and the mean transverse dimension was 3.35 ± 0.66 mm (3.25 ± 0.57 mm on the right side, 3.45 ± 0.73 mm on the left side) . The mean distance of foramen ovale from articular tubercle on zygomatic arch was 32.58 ± 1.29 mm (32.41 ± 1.10 mm on the right side, 32.74 ± 1.45 mm on the left side) and from anterior root of zygomatic arch was 24.75 ± 1.70 (23.91 ± 0.85 mm on the right side, 25.59 ± 1.92 mm on the left side).CONCLUSIONSThere is no significant average difference between FO_AP_RT – FO_AP_LT. There is no significant average difference between FO Width_RT - FO_Width_LT. There is a significant average difference between FO to Art. Tubercle Right - FO to Art Tubercle left. There is a significant average difference FO to ant. root Right - FO to ant. root left.

Anatomical variations of intra-sphenoid sinus septations in a sample of Kashmiri population: a non-contrast computed tomography study

Background: The sphenoid sinus shows multitude of variations in pneumatization, size and pattern of septations leading to differences in its segmentation. Pre-operative knowledge of their attachment especially to posterolateral bony walls covering vital structures is of utmost importance for a safe trans-sphenoidal approach for various surgical procedures involving skull base. Non-contrast computed tomography (NCCT) with its ability to provide multiplanar reformations (MPR) with sharp algorithms is now a reference standard for visualization of these intra-sphenoid sinus septations preoperatively. The objective of this study was to determine the number and attachment of intra-sphenoid sinus septations in a Kashmiri population sample.Methods: NCCT head images of 591 patients in the age range of 16 to 75 years were analyzed retrospectively. Individuals with age less than 16 years, previous surgery involving skull base/sphenoid sinus, trauma causing hem sinus/fractures around skull base or having space occupying lesions around skull base/sphenoid sinus were excluded from the study. On the CT workstation multi-planar coronal, sagittal and axial reconstructions were performed and subsequently examined.Results: The age range was 16 to 75 years with mean age of 43.56 years of which 453 (76.6%) were males and 138 (23.4%) were females. Single intra-sphenoid septation was the most common anatomic variant in present study (79.7%) being complete in 71.7% and partial or incomplete in 8% of the examined subjects. Double septa were found in 11% inpresent study and more than 2 septae in 3.4%. After sellar attachment (51%) the next most common site of attachment was to the carotid canal (29.5%) (23% to left ICA and 6.5% to the right ICA).Conclusions: Intricate knowledge about sphenoid sinus, its pneumatization and anatomical variations in intra-sphenoid sinus septations and its relationship with the surrounding vital structures is of utmost importance before performing any endoscopic/open surgery involving skull base via trans-sphenoidal approach. The present study shows that a significant percentage of septal attachment to the carotid canal makes main sphenoidal septum as not so reliable landmark for endoscopic procedures as used to be in the pre-imaging era. Thus, preoperative CT is mandatory to avoid injuries to para-sellar neurovascular and glandular structures.

The septation of the sphenoidal air sinus: a cadaveric study / Septación del seno esfenoidal: investigación cadavérica

The purpose of this study was to investigate the sphenoidal sinus septation in a select South African population, and document the relation of the number and location of the septa to the structures intimately related to the sinus. The intersinus and intrasinus septa of the sinus, the number and attachments of the septa were recorded from forty five cadaveric head specimens. The sphenoidal sinus intersinus septa were recorded as follows: Type 0 (absent septum) in 7.5 %, Type 1 (single septum) in 65 % and Type 2 (double septa) in 22.5 % of cases. The incidence of intersinus septa deviating to the left was prevalent; hence, the right sphenoidal sinus was dominant. The occurrence of intrasinus septa was observed in 93.3 % of cases, with a higher prevalence in males. The intrasinus septa formed cave like chambers on the sinus walls in 65.6 % cases. Incidences of the intersinus septa attaching to sella turcica (ST) (46.25 %) were prevalent compared to cases where they attached to the internal carotid artery (ICA) (6.25 %), maxillary (MN) (1.25 %) and vidian (VN) (1.25 %) nerves. However, the intrasinus septa attached more to the ICA (52.63 %) compared to their attachment to the other neurovascular structures (ST - 26.32 %; MN - 5.36 % and VN - 2.63 %). Surgeons need to be aware of the complex anatomical variations of the sphenoidal sinus septation when performing endoscopic endonasal transsphenoidal surgeries.

El propósito de este estudio fue investigar la septación del seno esfenoidal en una población sudafricana y documentar la relación del número y la ubicación de los septos en relación a las estructuras íntimamente relacionadas con el seno. Los septos interseno e intraseno del seno, el número y las uniones de los septos se registraron a partir de cuarenta y cinco cadáveres. El septo interseno del seno esfenoidal se registró de la siguiente manera: Tipo 0 (tabique/septo ausente) en el 7,5 %, Tipo 1 (tabique/septo único) en el 65 % y Tipo 2 (tabiques/septos dobles) en el 22,5 % de los casos. La incidencia de septos intersenos desviados hacia la izquierda fue prevalente. Por lo tanto, el seno esfenoidal derecho fue dominante. La ocurrencia de septo intraseno se observó en el 93,3 % de los casos, con una mayor prevalencia en varones. Los septos intrasenos formaron cámaras, como cuevas, en las paredes del seno en un 65,6 % de los casos. La incidencia de septos intersenos que se adhieren a la silla turca (ST) (46,25 %) fueron prevalentes en comparación con los casos en que se unieron a la arteria carótida interna (ACI) (6,25 %), al nervio maxilar (NM) (1,25 %) y nervio vidiano (NV) (1.25%). Sin embargo, los septos intersenos se adhirieron más a la ACI (52,63 %) en comparación con su unión a otras estructuras neurovasculares (ST - 26,32 %; NM -5,36 % y NV - 2,63 %). Los cirujanos deben ser conscientes de las complejas variaciones anatómicas de la tabicación del seno esfenoidal cuando se realizan cirugías transesfenoideas endonasales endoscópicas.

Variant Anatomy of the Jugular Foramen: An Osteological Study.

Background: Jugular foramen lesions are among the major complications of skull base surgery. Morphological variations in the structure are pertinent during interpretation of skull base radiographs and in surgical procedures within the foramen. This study therefore aimed at describing the morphology of the jugular foramen in a Kenyan population. Methods: One hundred and five adult skulls from the Nairobi National Museums were used. Jugular foramen septation, dome and dimensions were studied extracranially. Statistical analysis was performed using SPSS (Version 21.1 IBM). Results: Septation was present in 202 (96.2%) jugular foramina, type I partial septation being the most common (78.7%). A dome was observed in 81 (38.6%) jugular foramina. Respectively, the mean right and left anteroposterior dimensions were 11.17 ±2.05mm vs.8.88 ±2.30mm (p <0.001), mediolateral dimensions 17.47 ±2.18mm vs. 15.30 ±2.53mm (p <0.001), jugular dome depth 12.38 ± 2.64 mm vs. 11.25 ± 2.15 mm (p=0.054), posterior wall thickness7.95 ± 2.20mm vs. 9.68 ± 1.98mm (p <0.001) and medial wall thickness 3.73 ± 1.10 mm vs. 3.73 ± 0.98mm (p = 0.992). Conclusion: Partial septation, asymmetry in dimensions and a wide range in the dome depth of the jugular foramen were frequent. Preoperative imaging of jugular foramen morphology is therefore recommended to avoid inadvertent injury to its contents and surrounding structures owing to variability.

Preoperative risk factors in recurrent endometrioma after primary conservative surgery

OBJECTIVE: Endometriosis is a common gynecological disorder caused by ectopic implantation of endometrial glandular and stromal cells outside the uterine cavity. Among several types of endometriosis, endometrioma is the only subtype that could be determined preoperatively using pelvic ultrasonography, and guidelines recommend pathologic confirmation of endometrioma greater than 3 cm in diameter. However, although surgery is performed in cases of endometrioma, endometrioma has a high cumulative rate of recurrence. Therefore, because determining the possibility of recurrence before performance of initial surgery is important, we examined preoperative factors associated with recurrent endometrioma. METHODS: This was a retrospective, comparative study including 236 patients who visited the outpatient clinic between January 2009 and December 2011. Patients who were pathologically diagnosed with endometrioma were included in this study. They were followed up postoperatively and were divided into two groups according to presence of recurrent endometrioma. RESULTS: We examined associations between baseline factors and recurrent endometrioma. In multivariate analysis, dysmenorrhea and cyst septation were statistically significant after adjusting with age, parity, surgical staging and postoperative management. We examined cumulative recurrence free survival within cases of recurrent endometriosis, based on the presence of inner cyst septation. The cumulative recurrence free survival was lower in cases with septation. CONCLUSION: Our study found that recurrent endometrioma is more likely in patients with inner cyst septation and the recurrence occurred within a shorter duration of time than in patients without inner cyst septation on preoperative ultrasonography. Therefore intensive caution and postoperative long term medical therapy would be appropriate in patients with inner cyst septation on preoperative ultrasonography before undergoing primary surgery for endometrioma.

Perinatal Prognosis in Cystic Hygroma According to the Presence of Septation / 대한산부인과학회잡지

OBJECTIVE: We evaluated the association between perinatal prognosis and the presence of septation in cystic hygroma deteted by antenatal ultrasonography. METHODS: During a 5-year period, 65 cases of cystic hygroma were diagnosed by antenatal ultrasonography. 31 cases were included in this study. Fetal karyotyping, hydrops, and associated anomalies were compared between septated and non-septated groups. Statistical analysis was performed using Fisher exact test. RESULTS: There were 24 cases of septated cystic hygromas, and 7 cases of nonseptated cystic hygromas. Sixty-three percent of the septated cystic hygromas had accompanying hydrops and other anomalies (15/24), versus 28% (2/7) in the nonseptated group (p=0.022). Other anomalies such as cleft lip and palate, omphalocele, and club foot were more frequently seen in the septated group. Nine of 14 cases of septated cystic hygroma that underwent karyotying showed aneuploidy (64%), compared with 0% (0 of 6 cases) aneuploidy rate in the nonseptated cystic hygroma group (p=0.014). CONCLUSION: Abnormal fetal karyotyping, hydrops, and other anomalies are more likely to be associated in fetuses with septated cystic hygroma. So, the presence of septation may be the useful prognostic indicator of cystic hygroma.