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.

Fístula Liquórica Esfenoidal Espontânea ­ relato de caso / Spontaneous sphenoidal liquor fistula - Case report

Introdução: fístula liquórica rinogênica é uma comunicação do espaço subaracnóideo com a fossa nasal ou seios paranasais, decorrentes a um defeito anatômico da dura-máter, osso e mucosa. As fístulas liquóricas nasais espontâneas são eventos raros, cerca de 3%, com possíveis complicações deletérias e uma causa definida. Relato de caso: o caso relatado é de paciente de 47 anos, com queixa de cefaleia de forte intensidade, diagnosticado com fístula liquórica esfenoidal espontânea. Conclusão: o otorrinolaringologista tem importante papel em realizar o diagnóstico e assistir o paciente com fístula liquórica rinogênica.

Introduction: rhinoid cerebrospinal fluid fistula is a communication of the subarachnoid space with the nasal fossa or paranasal sinuses, due to an anatomical defect of the dura mater, bone and mucosa. Spontaneous nasal fluid fistulas are rare events, about 3%, with possible deleterious complications and a definite cause. Case report: the case reported is a 47-year-old patient complaining of severe headache, diagnosed with spontaneous sphenoidal cerebrospinal fluid fistula. Conclusion: has an important role in the diagnosis and assistance of cases with rhinoid cerebrospinal fluid fistula.

Anatomía radiológica del seno esfenoidal: análisis en 120 pacientes intervenidos / Radiologic anatomy of sphenoidal sinus, analysis of 120 surgically intervened patients

Introducción: La patología tumoral hipofisiaria es una consulta frecuente en Neurocirugía. La vía de abordaje a elegir preferentemente es transesfenoidal. Por esto, es de suma importancia conocer la anatomía de los senos paranasales cuando se planifica este abordaje. Materiales y Métodos: Se describe la anatomía radiológica de estudios por Tomografía Computada (TC) y Resonancia Magnética (RM) de 120 pacientes con diagnóstico de adenoma hipofisiario, que se sometieron a cirugía transesfenoidal de hipófisis, prestando especial interés en la morfología de las cavidades paranasales esfenoidales. Resultados: Tipo de neumatización: preselar 25 por ciento y postselar 75 por ciento; Septos: simples 45 por ciento y múltiples 55 por ciento; diámetros promedio: antero-posterior 2,3 cm, transverso: 3,3 cm y vertical: 2,25 cm. Los Senos esfenoidales con neumatización postselar tienen un diámetro anteroposterior significativamente mayor (P < 0,005) que los preselares. Los senos esfenoidales con septo simple tienen un diámetro transverso significativamente mayor (P < 0,007) que los con múltiples septos. El 50 por ciento de los septos siguen una trayectoria paramediana, y el 50 por ciento se desvía hacia una de las arterias carótidas. Conclusión: se confirma la gran variación anatómica del seno esfenoidal siendo independiente del sexo del paciente, además hemos constatado que la relación establecida por los septos intraselares con elementos vasculares intracraneales es muy variable, siendo este hallazgo de suma importancia en la planificación preoperatoria. Los hallazgos realizados por Tomografía computada (TC), pueden ser homologables a lo descrito por otros autores en disecciones cadavéricas.

Introduction: The pituitary tumor pathology is a common query in Neurosurgery. The choice of approach is transsphenoidal preferably, so it is extremely important to know the anatomy of the sinuses when planning this approach. Materials and Methods: We describe the radiological anatomy studies Computerized tomography (CT) and Magnetic Resonance (MR) of 120 patients with pituitary adenoma who underwent transsphenoidal pituitary surgery, with special attention to the morphology of the sphenoid sinuses. Results: Neumatization type: pre-sellar 25 percent and 75 percent post-sellar; Septa: Single 45 percent, multiple 55 percent, mean diameters: 2.3 cm anteroposterior, transverse: 3.3 cm and vertical: 2.25 cm. The sphenoid sinuses with postsellar neumatization have anteroposterior diameter significantly higher (P < 0.005) than the pre-sellar. The sphenoid sinuses are single septum transverse diameter significantly higher (P < 0.007) than those with multiple septa. The 50 percent of the septa paramedian follow a path, and 50 percent is diverted to one of the carotid arteries. Conclusion: Results support the large sphenoid sinus anatomical variation is independent of patient sex, and we found that the relationship established by the intrasellar septa with intracranial vascular elements is very variable, this finding being paramount in preoperative planning. The findings by computed tomography (CT) may be comparable to that described by other authors in cadaveric dissections.

A Case of Sphenoidal Sinus Carcinoma Associated with Partial Oculomotor and Abducens Nerve Palsy

PURPOSE: To report a rare case of a patient with diplopia due to a mass in the sphenoidal sinus, histologically diagnosed as carcinoma. CASE SUMMARY: A 57-year-old male visited our clinic complaining of diplopia and ptosis for 10 days. He had esotropia 45 prism diopters in the primary position, markedly limited abduction, and a 4 mm dilated pupil in the right eye compared with a 2 mm pupil in the left eye. Enhanced magnetic resonance imaging revealed a sphenoidal sinus mass extended into the pituitary gland and sella turcica with homogeneous intense enhancement. Metastatic workups, including CT of the head, neck, chest, and abdomen were unremarkable. He underwent a transsphenoidal approach mass debulking surgery followed by radiotherapy for 6 weeks. Histological findings were compatible with carcinoma. Six weeks after radiotherapy he had esotropia of 20 prism diopters in the primary position. Abduction limitation was partially recovered postoperatively. CONCLUSIONS: Diplopia may develop as a result of multiple cranial nerve palsy due to carcinoma in the sphenoidal sinus and may be improved by debulking surgery and radiation treatment.

Estudio endoscópico de la anatomía del seno esfenoidal en cadáveres / Endoscopic study of the anatomy of the sphenoid sinus in cadavers

Introducción: El seno esfenoidal presenta una relación íntima con diversas estructuras nobles de la base del cráneo. Objetivo: El objetivo de este estudio es describir la anatomía del seno esfenoidal utilizando la vía endoscópica transnasal directa. Material y método: Médicos del Servicio de Otorrinolaringología del Hospital Barros Luco Trudeau realizaron las disecciones en cadáveres del Servicio de Anatomía Patológica de la misma institución. Se realizaron diversas mediciones de la fosa nasa en relación al seno esfenoidal y se observaron la características del seno esfenoidal en relación a las estructuras neurovasculares que se proyectan en la pared. Resultados: Se estudiaron veinte cadáveres con una mediana de edad de 70 años. El 65% eran de sexo masculino. El 65% presentó configuración selar. El 60% de los senos presentaron múltiples septos. El ostium esfenoidal se encontró en la mayoría de los casos medial al cornete superior. Se apreció proyección en el seno del 80%% de carótidas (con 5%% de dehiscencias), 85%% de nervios ópticos, 40%% de nervios maxilares, 15%% de nervios vidianos, y 15%% de celdas de Onodi. Conclusiones: El seno esfenoidal es una estructura compleja relacionada con estructuras nobles que se proyectan al interior de éste, por lo que su conocimiento acabado es fundamental para su abordaje quirúrgico y de la base de cráneo.

Introduction: The sphenoidal sinus has an intimate relationship with critical structures and their exposure in the sinus walls depend on the pneumatization degree. Aim: The aim of this study is to describe the anatomy of the sphenoid sinus using direct transnasal endoscopic approach on a sample of adult corpses. Material and method: We performed endoscopic dissection of twenty corpses of the Pathology Department of the Hospital Barros Luco Trudeau. Various measurements were made from the nostrils. A description of the neuro-vascular structures projected into the sinus was performed. Results: The median age was 70 years. 65% were male. 65% of the sinuses had sellar configuration. 60%% of the sinuses had multiple septa. The sphenoid ostium was in most cases located medial to the superior concha. 80% of the carotid arteries were projected into the sinuses (5(0)% were dehiscent). 85%% of the optic nerves, 40%% of maxillary nerves, and 15%% of vidian nerves were observed in the sinuses. Onodi cells were found in 15% of the sinuses. Conclusions: The sphenoid sinus is a complex structure adjacent to delicate structures. It is essential to be aware of these structures and their anatomical variations to perform a safe surgical approach of the sphenoid sinus and skull base.

Operation pathways for sphenoidal sinus by nasal endoscope and treatments for correlated diseases beyond scope of sphenoidal sinus / 临床耳鼻咽喉头颈外科杂志

Objective:We probe more direct operation pathways in sphenoidal sinus and saddle area, and take proper measures for correlated diseases which surpass scope of sphenoidal sinus by combining image data, which could prevent serious complication.Method:Under nasal endoscope, the operation approaches we adopted included trans-anterior ethmoid sinus-posterior ethmoid sinus-sphenoidal sinus pathway, trans-meatus nasi superior-posterior ethmoid sinus-sphenoidal sinus pathway, trans nasal septum-sphenoidal sinus pathway and trans-natural opening of sphenoid sinus anterior into sphenoid sinus pathway by taking upper edge of posterior naris as a consistent surgical landmark. Forty-six cases who had sphenoidal sinus mass with bone erosion recieved surgical treatment.Result:Twenty-one cases with cyst and pus cyst of sphenoidal sinus had been healed by trans-meatus nasi superior pathway;1 case with hematoma and organization in sphenoidal sinus had been cleared by trans-meatus nasi superior pathway;3 cases had hematoma and organization in sphenoidal sinus and pseudoaneurysm in internal carotid artery,one of them suffered fatal hemorrhage in surgical exploration, and cured by endovascular embolization, the other two only underwent nasal endoscopic examination,the diagnosis was established by DSA and they received interventional therapy;4 cases with papilloma in sphenoidal sinus had been treated by trans-natural opening of sphenoid sinus approach,and 3 cases were cured,1 case had only partial mass resection as the papilloma offended the outer wall of sphenoidal sinus diffusely;2 cases with cholesteatoma of sphenoid sinus have been removed completely by trans-meatus nasi superior approach;1 case with encephalomeningocele of sphenoidal sinus underwent sphenoidotomy by trans-natural opening of anterior of sphenoidal sinus, and intraoperative puncture showed characteristic cerebrospinal fluid,the exposed meninges were then repaird surgically;1 case with mycosis of sphenoidal sinus had been cured by thorough clearing of the leision in sphenoidal sinus combined with antifungal therapy;3 cases with malignancy of sphenoidal sinus had received major mass resection of sphenoidal sinus by trans-anterior ethmoid sinus-posterior ethmoid sinus approach, and followed with radio therapy and chemotheraphy;5 cases with NPC in-volving sphenoidal sinus had been treated by radio therapy and chemotherapy after pathological examinacation;5 cases with post-operative cerebrospinal rhinorrhea and granulation hyperplasia of sphenoidal sinus had been repaired successfully by trans-meatus nasi superior approach or tans-nasal septum approach.Conclusion:There are various surgical pathways to deal with sphenoidal sinus and correlated diseases under nasal endoscope.The operation will be direct, safe and minimal invasive if we choose the pathway properly. Thin slice CT scan and 3D reconstruction of sella, and DSA or angiography of brain before operation is one of effective means to prevent surgical complications for leisions beyond scope of sphenoidal sinus.

Interventional Treatment of the Subclinoid Part of the Internal Carotid Artery Break into Sphenoidal Sinus / 介入放射学杂志

This paper reported the method of the subclinoid part of the internal carotid artery break in to sphenoidal sinus. Materials and Methods: The 3 cases suffered from parabasal fractures of the skull during head trauma. The false aneurysm of the subclinoid part of the internal carotid artery broke into sphenoidal sinus and caused fatal nasal hemorrhages. Selective internal carotid arteriographies were made through femoral artery, approach. BALTs were put into the ruptured places of the arteries after di agnoses were confirmed. Results: In the above cases the internal carotid arteries were occluded and profuse nasal hemorrhages stopped and did not appear again in the follow up period (6 months-3 years) . Conclusion: The method presented in the paper is a simple, safe and reliable one for the treatment of profuse nasal bleeding caused by parabasal fractures of the skull.

Applied anatomy of anterior wall of sphenoid sinus for transsphenoidal endoscopic sella surgery / 第二军医大学学报

Objective:To provide anatomic data for accurately localizing aperture of sphenoidal sinus without injurying sphenopalatine arteries in endoscopic transsphenoidal sella surgery.Methods: The anterior walls of spheroid sinus were observed and measured(layout,position,external diameter,distances to other structures of interest) with a vernier caliper and an angle gauge on 15 adult cadavers.Results: The distances from the root of columella nasi to the inforior pole of sphenoidal sinus aperture and the sphenopalatine foramen were(60.40?3.21,58.10-72.76) mm and(62.14?1.93,59.50-73.40) mm,respectively.The distance from the inforior pole sphenoidal sinus aperture to the sphenopalatine foramen was(12.20?1.10,8.10-16.35) mm.The diameter of the sphenopalatine artery was(1.99?0.13,1.50-2.80) mm.The distances from the inforior pole of sphenoidal sinus aperture to the superior and inferior posterior artery of nasal septum were(3.49?0.24,2.78-5.20) mm and(6.42?1.08,(4.30-8.50)) mm,respectively.Conclusion: Aperture of sphenoidal sinus is an important marker in endosopic transsphenoidal sella surgery.The anterior wall of sphenoid sinus should be opened from the inforior pole of sphenoidal sinus aperture to avoid injurying sphenopalatine artery.