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Objective:To study the clinical anatomy of the sphenopalatine foramina by dissecting the sphenopalatine foramina during Vidian nerve branch neurotomy. The anatomy and CBCT images of sphenopalatine foramen were analyzed to facilitate the navigational of clinical operation using CBCT images. Methods:From October 2017 to September 2023, 84 casesï¼168 sidesï¼ of Vidian nerve branch neurotomy in our department were collected. The clinical summary was made according to the anatomy of sphenopalatine foramen during the operation. Preoperative CBCT imaging findings of the sphenopalatine foramina were also studied. Results:The clinical anatomy of sphenopalatine foramen could be divided into four types: middle meatus typeï¼1.19%ï¼, trans-meatus typeï¼62.29%ï¼, superior meatus typeï¼33.33%ï¼ and double foramen typeï¼1.19%ï¼. The incidence of ethmoidal ridge was 98.81%. The distance from sphenopalatine foramina to posterior nasal canal wereï¼14.63±2.66ï¼ mm to left andï¼14.65±2.63ï¼ mm to right, The position Angle â a of lower margin of sphenopalatine foramina wereï¼62.36±10.05ï¼° to left andï¼61.51±11.82ï¼° to right, respectively. Axial CT images can be used to divide the sphenopalatine foramen into five levels: the upper edge of the sphenopalatine foramen level, the Vidian nerve level, the basal plate interaction level, the lower edge of the sphenopalatine foramen level and the pterygopalatine canal level. The agreement between endoscopic anatomy of sphenopalatine foramen and imaging navigation was 100%. Conclusion:The sphenopalatine foramina exhibit various anatomical types. The preoperative navigational CBCT reading can effectively identify the type of sphenopalatine foramina, guide the choice of surgical method, and help avoid serious complications. This has significant clinical application value.
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Tomografía Computarizada de Haz Cónico , Endoscopía , Humanos , Tomografía Computarizada de Haz Cónico/métodos , Endoscopía/métodos , Masculino , Femenino , Persona de Mediana Edad , Hueso Esfenoides/diagnóstico por imagen , Hueso Esfenoides/anatomía & histología , Adulto , Cavidad Nasal/diagnóstico por imagen , Cavidad Nasal/anatomía & histologíaRESUMEN
PURPOSE: This examination aimed to display the size and topographic position of the Vidian canal (VC) in normal children. METHODS: 180 pediatric subjects aged 1-18 years were included this computed tomography examination. The distances of VC to certain landmarks, and VC length were measured. The locations of VC according to the sphenoid sinus, and the medial plate of pterygoid process were classified as three types, separately. RESULTS: The distances of VC to the vomerine crest, midsagittal plane, round foramen, and the superior wall of sphenoid sinus were measured as 12.68 ± 3.17 mm, 10.76 ± 2.52 mm, 8.62 ± 2.35 mm, and 14.16 ± 5.00 mm, respectively. The length and angle of VC were measured as 12.00 ± 2.52 mm, and 16.60 ± 9.76°, respectively. According to the sphenoid bone, VC location was identified as Type 1 in 113 sides (47.5%), as Type 2 in 70 sides (29.4%), and as Type 3 in 55 sides (23.1%). According to the medial plate of pterygoid process, VC location was identified as Type A in 274 sides (76.1%), as Type B in 55 sides (15.3%), and as Type C in 31 sides (8.6%). VC location types correlated with pediatric ages, but not sex or side. CONCLUSION: With advancing pediatric age, the protrusion of VC into the sphenoid sinus increases, and VC shifts from medial to lateral side of the medial plate of pterygoid process.
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Seno Esfenoidal , Tomografía Computarizada por Rayos X , Humanos , Niño , Masculino , Femenino , Adolescente , Preescolar , Lactante , Seno Esfenoidal/diagnóstico por imagen , Seno Esfenoidal/anatomía & histología , Hueso Esfenoides/diagnóstico por imagen , Hueso Esfenoides/anatomía & histología , Puntos Anatómicos de Referencia , Valores de ReferenciaRESUMEN
PURPOSE: To describe the relation of the sphenoid ridge (SR) with the surrounding anatomical structures in healthy children when approaching the anterior and middle fossae. METHODS: Computed tomography of 180 pediatric patients (90 males / 90 females), aged 1-18 years were included the study. The size of the lesser wing (LW) and the distances of the LW to certain landmarks were measured. RESULTS: The LW length was 28.48 ± 8.15 mm. The LW widths at the midline and the midpoint and lateral point of the SR were 7.78 ± 1.74 mm, 2.84 ± 0.81 mm, and 1.91 ± 0.64 mm, respectively. The distance between the midpoint of the SR and the crista galli was 28.22 ± 5.56 mm, and the distance between the crista alaris and internal auditory meatus was 51.73 ± 5.79 mm. The linear function was calculated as y = 18.748 + 1.024 × age for SR length, y = 6.046 + 0.182 × age for the midline width of SR, y = 2.367 + 0.050 × age for the midpoint width of SR, y = 1.249 + 0.069 × age for the crista alaris width, y = 21.727 + 0.683 × age for the distance between the SR midpoint and the crista galli, and y = 43.614 + 0.855 × age for the distance between the crista alaris and internal auditory meatus. CONCLUSION: All measured parameters increased irregularly with advancing age. Furthermore, our regression equations representing the growth dynamics of SR may be used to estimate these parameters.
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Hueso Esfenoides , Tomografía Computarizada por Rayos X , Humanos , Masculino , Femenino , Niño , Adolescente , Hueso Esfenoides/anatomía & histología , Hueso Esfenoides/diagnóstico por imagen , Preescolar , LactanteRESUMEN
BACKGROUND: In human anatomy, there are well-known the foramina of the greater sphenoidal wing, the foramen rotundum, the foramen ovale, the foramen spinosum, as well as the inconstant sphenoidal emissary foramen of Vesalius and the foramen of Arnold. Different canals are found in several species of rodents, such as the alisphenoid and sphenopterygoid (SPC) canals. METHOD: It was re-explored an archived computed tomography angiogram of a 60 y.o. female case. RESULTS: Bilateral superior recesses of the pterygoid fossae (SRPF) and a right SPC were found. The SRPF on each side penetrated the non-lamellar pterygoid root and superiorly reached the sphenoidal sinus wall. Upper fibres of medial pterygoid muscles were inserted into each SRPF. An unexpected SPC was found on the right side. It opened superiorly on the lateral side of the foramen rotundum and inferiorly at a pterygoid foramen in the superior end of the posterior margin of the lateral pterygoid plate. A sphenoidal emissary vein traversed that SPC to drain into the pterygoid plexus. CONCLUSION: The SRPF and SPC could also be found in humans. As the sphenoidal emissary veins are surgically relevant, they should not be further regarded as exclusively crossing the foramen of Vesalius but also the SPC.
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Hueso Esfenoides , Humanos , Femenino , Hueso Esfenoides/diagnóstico por imagen , Hueso Esfenoides/anatomía & histología , Angiografía por Tomografía Computarizada , Seno Esfenoidal/anatomía & histología , Seno Esfenoidal/diagnóstico por imagen , Persona de Mediana Edad , Músculos Pterigoideos/anatomía & histología , Músculos Pterigoideos/diagnóstico por imagen , Variación AnatómicaRESUMEN
OBJECTIVE: This study aimed to examine pneumatization and topographic location of the posterior clinoid process (PCP) in Chiari type I malformation (CIM) for skull base approaches. METHODS: Computed tomography images of 52 (23 males/29 females) CIM subjects aged 23.87 ± 16.09 years and 71 (26 males/45 females) healthy subjects aged 42.48 ± 21.48 years constituted the study universe. RESULTS: The distances of PCP to the foramen magnum (P = 0.037), superior orbital fissure (P < 0.001), foramen rotundum (P < 0.001), and foramen ovale (P < 0.001) were smaller, but the distance of PCP to the crista galli (P = 0.038) was greater in CIM patients, compared with normal subjects. In CIM, the fusion between PCP and the anterior clinoid process was observed in 9 sides (8.70%), while in controls it was observed in 12 sides (8.50%). PCP pneumatization was observed in 40 sides (38.50%) in CIM patients, while it was observed in 28 sides (19.70%) in normal subjects. These data displayed that PCP pneumatization was affected by CIM (P < 0.001). CONCLUSIONS: The distances of PCP to the crista galli and foramen magnum indicate the anterior fossa length and the posterior fossa depth, respectively; thus CIM patients have a longer anterior fossa and a shallow posterior fossa. In addition, the distances of PCP to the superior orbital fissure, foramen rotundum, and foramen ovale indicate the middle fossa width; hence CIM patients have less middle fossa width than normal individuals. CIM patients have an approximately 50% higher PCP pneumatization rate, and this may increase the risk of complications such as cerebrospinal fluid fistula during the application of posterior clinoidectomy.
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Malformación de Arnold-Chiari , Tomografía Computarizada por Rayos X , Humanos , Malformación de Arnold-Chiari/diagnóstico por imagen , Masculino , Femenino , Adulto , Adulto Joven , Adolescente , Persona de Mediana Edad , Base del Cráneo/diagnóstico por imagen , Base del Cráneo/anatomía & histología , Foramen Magno/diagnóstico por imagen , Foramen Magno/anatomía & histología , Hueso Esfenoides/diagnóstico por imagen , Hueso Esfenoides/anatomía & histologíaRESUMEN
Cattle disorders affecting the sphenoid sinus are underreported, likely due to difficulties in imaging and lacking topographic knowledge. This study aimed to provide a detailed description of the normal anatomical and morphometric features of the cattle sphenoid sinus. Twelve healthy adult Holstein cow heads were used, and the sinus was examined using CT, anatomical sectioning and 3D modelling. The sinus was bilaterally detected in all animals but exhibited structural asymmetry and significant interindividual differences in morphological characteristics. Three parts of the sinus were defined, namely the rostral, median and alar parts, which conform to the morphological structure of the sphenoid bone. The rostral part was bilateral in shape and located on the orbit wall of the presphenoid bone in all animals. The median part, which pneumatized the body of the sphenoid bone, was observed bilaterally in seven animals, while the alar part, which pneumatized the wing of the sphenoid bone, was formed bilaterally in four animals. The sinus volume and surface area were 11 ± 8 cm3 and 49 ± 30 cm2 , respectively. These findings may aid in the diagnosis of cattle sphenoid sinus disorders and contribute to the knowledge of regional anatomy for radiologists and clinicians.
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Senos Paranasales , Seno Esfenoidal , Femenino , Bovinos , Animales , Seno Esfenoidal/diagnóstico por imagen , Seno Esfenoidal/anatomía & histología , Seno Esfenoidal/cirugía , Hueso Esfenoides/diagnóstico por imagen , Hueso Esfenoides/anatomía & histología , Órbita/anatomía & histología , Procesamiento de Imagen Asistido por ComputadorRESUMEN
Background: The foramen spinosum (FS) is a pivotal passage for neurovascular structures within the skull base. We performed a detailed morphometric and morphological analysis of the FS to emphasize its clinical relevance. Materials & Methods: The study was performed on dried skull specimens obtained from the anatomical collections of the Institute of Anatomy and Institute of Forensic Medicine of the University of Ljubljana. The morphometric and morphologic features of FS in 126 whole human skulls and 15 skull halves were analyzed, including dimensions, shape, and other anatomical variations, as well as relationships to surrounding structures. Measurements were done with a digital sliding caliper. Results: The mean length and width of the FS were 2.45 ± 0.65 mm and 2.03 ± 0.53 mm on the right side and 2.49 ± 0.61 mm and 2.08 ± 0.48 mm on the left side. The most frequently observed shape was round (56.7%), followed by oval (28.2%), irregular (8.7%) and drop shaped (6.3%). Several anatomical variations were also noted, including FS duplication, confluences with other foramina, and FS obstruction due to marginal bony outgrowths. Conclusion: The FS exhibits notable interindividual differences in anatomical characteristics which should be considered during neurosurgical procedures and radiological interventions in the skull base.
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Base del Cráneo , Hueso Esfenoides , Humanos , Hueso Esfenoides/anatomía & histología , Base del Cráneo/diagnóstico por imagen , Procedimientos NeuroquirúrgicosRESUMEN
SUMMARY: For the treatment of trigeminal neuralgia, the foramen ovale is reached by entering the cheek with a needle. Thermocoagulation is performed with balloon compression, administration of alcohol or radiofrequency. Apart from the classical method, it is theoretically possible to reach the foramen ovale through the mouth with the anterior approach. In our study, it was aimed to examine horizontally and vertically the angular values that must be given to the needle to reach the foramen ovale in the anterior approach. Three landmark points were determined on both right and left sides of 25 dry skulls. A rod was inserted starting from these landmark points and passing through the center of the foramen ovale. The vertical and horizontal angular values of this bar were measured. For each foramen ovale, 3 vertical angles, 3 horizontal angles and 4 distance measurements were made. There was a significant difference between the right and left sides in terms of horizontal angular values. Average values of horizontal angles (in degrees); on the right, 7.29 for H1, 12.15 for H2, 32.29 for H3; 1.26 for H1, 9.46 for H2, and 30.56 for H3 on the left side (p<0.005). The angle value was measured as 0 or negative value in 5 (20 %) of the H1 angle measurements made on the right side and 14 (56 %) on the left side. The H2 angle value was found to be smaller than the H1 angle in the skull 2 (8 %) on the right and 3 (12 %) on the left. There was no difference between the right and left sides in terms of vertical angular values. A significant difference was found between the right and left sides in the D1, D2, D4 distances (p<0.005). Six important anatomical features affecting angular values were encountered.
Para el tratamiento de la neuralgia del trigémino, se alcanza el foramen oval introduciendo una aguja en la mejilla. La termocoagulación se realiza con compresión con balón, administración de alcohol o radiofrecuencia. Aparte del método clásico, en teoría es posible alcanzar el foramen oval a través de la cavidad oral mediante el abordaje anterior. En nuestro estudio se tuvo como objetivo examinar horizontal y verticalmente los valores angulares que se deben dar a la aguja para alcanzar el foramen oval en el abordaje anterior. Se determinaron tres puntos de referencia en los lados derecho e izquierdo de 25 cráneos secos. Se insertó una varilla comenzando desde estos puntos de referencia y pasando por el centro del foramen oval. Se midieron los valores angulares verticales y horizontales de esta barra. Para cada foramen oval se realizaron mediciones de 3 ángulos verticales, 3 ángulos horizontales y 4 distancias. Hubo una diferencia significativa entre los lados derecho e izquierdo en términos de valores angulares horizontales. Valores medios de ángulos horizontales (en grados); a la derecha, 7,29 para H1, 12,15 para H2, 32,29 para H3; 1,26 para H1, 9,46 para H2 y 30,56 para H3 en el lado izquierdo (p<0,005). El valor del ángulo se midió como 0 o valor negativo en 5 (20 %) de las mediciones del ángulo H1 realizadas en el lado derecho y 14 (56 %) en el lado izquierdo. Se encontró que el valor del ángulo H2 era menor que el ángulo H1 en el cráneo 2 (8 %) a la derecha y 3 (12 %) a la izquierda. No hubo diferencia entre los lados derecho e izquierdo en términos de valores angulares verticales. Se encontró diferencia significativa entre el lado derecho e izquierdo en las distancias D1, D2, D4 (p<0,005). Se encontraron seis características anatómicas importantes que afectan los valores angulares.
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Humanos , Hueso Esfenoides/anatomía & histología , Rizotomía , Puntos Anatómicos de ReferenciaRESUMEN
OBJECTIVE: The anterior clinoid process (ACP) is surrounded by nerves and vessels that, together, constitute an intricate anatomical structure with variations that challenges the performance of individualized anterior clinoidectomy in treating lesions with different extents of invasion. In the present study, we established a 6-surface system for the ACP based on anatomical landmarks and analyzed its value in guiding ACP drilling and resection of paraclinoid meningiomas. METHODS: Using the anatomical characteristics of 10 dry skull specimens, we set 9 anatomical landmarks to delineate the ACP into 6 surfaces. Guided by our 6-surface system and eggshell technique, 5 colored silicone-injected anatomical specimens were dissected via a frontotemporal craniotomy to perform anterior clinoidectomy. Next, 3 typical cases of paraclinoid meningioma were selected to determine the value of using our 6-surface system in tumor resection. RESULTS: Nine points (A-H and T) were proposed to delineate the ACP surface into frontal, temporal, optic nerve, internal carotid artery, cranial nerve III, and optic strut surfaces according to the adjacent tissues. Either intradurally or extradurally, the frontal and temporal surfaces could be identified and drilled into depth, followed by skeletonization of the optic nerve, cranial nerve III, internal carotid artery, and optic strut surfaces. After the residual bone was removed, the ACP was drilled off. In surgery of paraclinoid meningiomas, our 6-surface system provided great benefit in locating the dura, nerves, and vessels, thus, increasing the safety of opening the optic canal and relaxing the oculomotor or optic nerves and allowing for individualized ACP drilling for meningioma removal. CONCLUSIONS: Our 6-surface system adds much anatomical information to the classic Dolenc triangle and can help neurosurgeons, especially junior ones, to increase their understanding of the paraclinoid spatial structure and accomplish individualized surgical procedures with high safety and minimal invasiveness.
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Aneurisma Intracraneal , Neoplasias Meníngeas , Meningioma , Humanos , Meningioma/diagnóstico por imagen , Meningioma/cirugía , Aneurisma Intracraneal/cirugía , Base del Cráneo/cirugía , Hueso Esfenoides/cirugía , Hueso Esfenoides/anatomía & histología , Neoplasias Meníngeas/diagnóstico por imagen , Neoplasias Meníngeas/cirugíaRESUMEN
SUMMARY: The study purposed to examine the morphometry and morphology of crista galli in cone beam computed tomography (CBCT) and apply a new analysis, supervised Machine Learning techniques to find the answers to research questions "Can sex be determined with crista galli morphometric measurements?" or "How effective are the crista galli morphometric measurements in determining sex?". Crista galli dimensions including anteroposterior, superoinferior, and laterolateral were measured and carried out on 200 healthy adult subjects (98 females; 102 males) aged between 18-79 years. Also, crista galli was classified with two methods called morphological types and Keros classification. In this study, the Chi-square test, Student's t-test, and Oneway ANOVA were performed. Additionally, Machine Learning techniques were applied. The means of the CGH, CGW, and CGL were found as 14.96 mm; 3.96 mm, and 12.76 mm in males, respectively. The same values were as 13.54 mm; 3.51 mm and 11.59±1.61 mm in females, respectively. The CG morphometric measurements of males were higher than those of females. There was a significant difference between sexes in terms of morphological classification type. Also, when the sex assignment of JRip was analyzed, out of 102 male instances 62 of them were correctly predicted, and for 98 female instances, 70 of them were correctly predicted according to their CG measurements. The JRip found the following classification rule for the given dataset: "if CGH<=14.4 then sex is female, otherwise sex is male". The accuracy of this rule is not high, but it gives an idea about the relationship between CG measurements and sex. Although the issue that CG morphometric measurements can be used in sex determination is still controversial, it was concluded in the analysis that CG morphometric measurements can be used in sex determination. Also, Machine Learning Techniques give an idea about the relationship between CG measurements and sex.
En el estudio se propuso examinar la morfometría y la morfología de la crista galli del hueso etmoides usando tomografía computarizada de haz cónico (CBCT) y aplicar un nuevo análisis, técnicas de aprendizaje automático supervisado para encontrar las respuestas a las preguntas de investigación "¿Se puede determinar el sexo con mediciones morfométricas de la crista galli?" o "¿Qué tan efectivas son las medidas morfométricas de la crista galli para determinar el sexo?". Las dimensiones de la crista galli, incluidas los diámetros anteroposterior, superoinferior y laterolateral, se midieron y realizaron en 200 sujetos adultos sanos (98 mujeres; 102 hombres) con edades comprendidas entre los 18 y los 79 años. La crista galli se clasificó con dos métodos llamados tipos morfológicos y clasificación de Keros. En este estudio, se realizaron la prueba de Chicuadrado, la prueba t de Student y ANOVA de una vía. Adicionalmente, se aplicaron técnicas de Machine Learning. Las medias de CGH, CGW y CGL se encontraron en 14,96 mm; 3,96 mm y 12,76 mm en hombres, respectivamente. Los mismos valores fueron 13,54 mm; 3,51 mm y 11,59 ± 1,61 mm en mujeres, respectivamente. Las medidas morfométricas del CG de los hombress fueron más altas que las de las mujeres. Hubo una diferencia significativa entre sexos en cuanto al tipo de clasificación morfológica. Además, cuando se analizó la asignación de sexo de JRip, de 102 instancias masculinas, 62 de ellas se predijeron correctamente, y de 98 instancias femeninas, 70 de ellas se predijeron correctamente de acuerdo con las mediciones de CG. El JRip encontró la siguiente regla de clasificación para el conjunto de datos dado: "si CGH<=14.4, por tanto el sexo es femenino, de lo contrario, el sexo es masculino". La precisión de esta regla no es alta, pero da una idea de la relación entre las medidas del CG y el sexo. Aunque la pregunta si las medidas morfométricas CG se pueden usar en la determinación del sexo sigue aún siendo controvertida. Se concluyó en el análisis que las medidas morfométricas CG se pueden usar en la determinación del sexo. Además, las técnicas de aprendizaje automático dan una idea de la relación entre las medidas de CG y el sexo.
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Hueso Esfenoides/diagnóstico por imagen , Hueso Etmoides/diagnóstico por imagen , Determinación del Sexo por el Esqueleto , Hueso Frontal/diagnóstico por imagen , Hueso Esfenoides/anatomía & histología , Hueso Etmoides/anatomía & histología , Tomografía Computarizada de Haz Cónico , Aprendizaje Automático , Hueso Frontal/anatomía & histologíaRESUMEN
The foramen ovale is one of the essential foramina in the middle cranial fossa, more precisely, in the superior surface of the greater wing of the sphenoid bone. It has essential surgical and diagnostic significance since it serves as a surgical landmark, and crucial neurovascular vessels such as the mandibular nerve and accessory meningeal artery pass through it. Therefore, understanding the morphological and morphometric variations of the foramen ovale is essential for accurately identifying, diagnosing, and managing related pathologies. The study aimed to evaluate the morphological variations and morphometric details of the foramen ovale in the Saudi population. A radiological study was conducted to observe the measurements and the shapes of the foramen ovale in the skull with its anatomical variants. Retrospective data was collected from the Department of Radiology, King Fahad University Hospital, Saudi Arabia. The sample consisted of 100 human skulls from computed tomography scans, including 50 males and 50 females. The values for the mean length, width, and distance from the midline on the right side were 6.462 mm ± 1.681 mm, 4.897 ± 1.0631 mm, and 2.4565 ± 0.51275 mm, and 6.451 ± 1.6691 mm, 4.812 ± 1.0848 mm and 2.4290 ± 0.60039 mm for the left side, respectively. The foramen shape was oval in the majority (47%), followed by round shape (31%) with no bony outgrowths such as spur in the studied foramina. Furthermore, the morphometric variation between males and females was statistically insignificant (p-value>0.05). The observed variation of foramen ovale in this study has significant anatomical and clinical applications for various diagnostic and surgical procedures.
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Foramen Oval , Radiología , Masculino , Femenino , Humanos , Foramen Oval/diagnóstico por imagen , Estudios Retrospectivos , Arabia Saudita , Hueso Esfenoides/anatomía & histologíaRESUMEN
BACKGROUND: The repair of lateral sphenoid sinus cerebrospinal fluid leaks is routinely accomplished through the use of the endonasal endoscopic approach (EEA) with a transpterygoidal extension. This approach can incur sinus morbidity, damage to the vidian, palatine and trigeminal nerves, and the contents of the pterygopalatine fossa, particularly if the encephalocele is lateral to the foramen rotundum (FR) and V2. OBJECTIVE: To investigate the use of the lateral transorbital approach (LTOA) as an alternative approach for repair of lateral sphenoid sinus encephaloceles that avoids the potential morbidity of EEA. METHODS: We performed cadaveric dissections of 2 specimens (4 sides) and present one of the first cases of a lateral sphenoid sinus encephalocele repair lateral to the FR in a patient through an ipsilateral LTOA. RESULTS: We find that the LTOA provides a shorter distance to target compared with the EEA (56 vs 89.5 mm, P = .002). The LTOA field of view also affords excellent visualization of both the medial and lateral aspects of V2, whereas the EEA is less effective at exposing lateral to V2, even after sacrifice of the vidian nerve and maximal pterygopalatine fossa content retraction. We report a case of LTOA to repair a meningoencephalocele lateral to V2 in the sphenoid sinus. CONCLUSION: The LTOA to the foramen rotundum is a more direct approach that minimizes the morbidity associated with EEA to repair meningoencephaloceles both medial and lateral to foramen rotundum.
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Encefalocele , Seno Esfenoidal , Humanos , Encefalocele/diagnóstico por imagen , Encefalocele/cirugía , Seno Esfenoidal/diagnóstico por imagen , Seno Esfenoidal/cirugía , Hueso Esfenoides/cirugía , Hueso Esfenoides/anatomía & histología , Nariz , CadáverRESUMEN
INTRODUCTION: Transsphenoidal surgeries imply the risk of intraoperative lesions to the neurovascular structures surrounding the sphenoid sinus (SS). Aim of the present study is to assess the metrical and morphologic relationships existing between SS and sella turcica (ST). MATERIALS AND METHODS: Two hundred computed tomography-scans of patients were selected. For each patient volumes of SS were calculated from their 3-dimensional models segmented through ITK-SNAP program. Variants of SS in pneumatisation and sellar diameters [antero-posterior (AP) diameter, depth, and length] were evaluated on each computed tomography-scan. Correlations among different measurements were assessed through Spearman test ( P <0.01), whereas associations between sellar parameters and presence of pneumatisation variants were assessed through Mann-Whitney test ( P <0.01). RESULTS: In males, pneumatization of the greater wings was related to smaller AP diameter ( P <0.01) and depth of ST ( P <0.01), whereas in females lower values of depth were found in patients with pneumatization of the pterygoid processes ( P <0.01). In both sexes, a positive correlation was found between AP diameter and, respectively, length and depth of ST ( P <0.01), together with a negative correlation between volume of SS and depth of ST ( P <0.01). Lastly, in females a positive correlation was found between age and, respectively, length and depth of ST ( P <0.01). CONCLUSIONS: The present study highlighted new metrical and morphologic relationships between volume and pneumatisation of SS and diameters of ST. Knowledge of these correlations allows to understand more clearly, in the preoperative setting, the surgical working space. Further studies are needed, especially for what concerns the relationship between sellar measurements and age in females.
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Silla Turca , Seno Esfenoidal , Masculino , Femenino , Humanos , Silla Turca/diagnóstico por imagen , Silla Turca/cirugía , Silla Turca/anatomía & histología , Seno Esfenoidal/diagnóstico por imagen , Seno Esfenoidal/cirugía , Seno Esfenoidal/anatomía & histología , Hueso Esfenoides/diagnóstico por imagen , Hueso Esfenoides/cirugía , Hueso Esfenoides/anatomía & histología , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: The present study aimed to evaluate the foramen venosum (FV) frequency, incidence, morphometry and relation with foramen ovale in an Indian population. The emissary vein passing through it may spread extracranial facial infections to the intracranial cavernous sinus. Due to its close proximity with the foramen ovale and its variable occurrence, awareness about its presence and anatomy is essential to neurosurgeons operating in this region. METHODS: 62 dry adult human skulls were studied for the occurrence and morphometry of foramen venosum, both at the middle cranial fossa and extracranial base of the skull. Dimensions were taken using Java-based image processing program, IMAGE J. After collection of data, appropriate statistical analysis was done. RESULTS: The foramen venosum was observed in 49.1% skulls. Its presence was noted more frequently at the extracranial skull base than in the middle cranial fossa. No significant difference was observed between the two sides. FV at the extracranial view of the skull base had a larger maximum diameter than in the middle cranial fossa; however, the distance between FV and the foramen ovale was found to be more at the middle cranial fossa than at the extracranial view of the skull base on both the right and left side. Variations in the shape of the foramen venosum were also observed. CONCLUSION: The present study is not only of great importance to anatomists, but also to radiologists and neurosurgeons for better planning and execution of the surgical approach to the middle cranial fossa through the foramen ovale to prevent iatrogenic injuries.
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Seno Cavernoso , Hueso Esfenoides , Adulto , Humanos , Hueso Esfenoides/anatomía & histología , Base del Cráneo/anatomía & histología , Fosa Craneal Media , CaraRESUMEN
BACKGROUND: Le Fort 1 (LF1) osteotomies are widely used to correct midface deformities. To move the maxilla freely, the ptery-gomaxillary junction (PMJ) must be separated. When performing this osteotomy, the pterygoid plate must remain intact. The objective of this study was to evaluate relationship between the anatomical features of the PMJ and fracture patterns in LF1 osteotomy. METHODS: Pre-operative and post-operative cone-beam computed tomography images of 41 patients (82 samples) who have undergone LF1 osteotomy surgery were radiologically evaluated. Morphologic measurements of the pterygomaxillary fissure area and pterygoid plate were carried out. Moreover, pterygomaxillary separation was divided into the clean-cut, maxillary sinus, and pterygoid plate fracture types. RESULTS: Statistically significant difference was observed between clean-type fracture and pterygoid plate fracture groups' thickness of the pterygoid process and thickness of the pterygomaxillary region. CONCLUSION: Anatomical variations make it difficult to separate the PMJ properly. Low thickness of PMJ increases the risk of unwanted fractures; however, according to our experience, the use of an osteotome with an incorrect angle, excessive force, and inexperienced surgeons can also cause undesirable pterygoid plate fractures.
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Fracturas Óseas , Humanos , Osteotomía Le Fort/métodos , Maxilar/diagnóstico por imagen , Maxilar/cirugía , Maxilar/anatomía & histología , Hueso Esfenoides/anatomía & histología , Hueso Esfenoides/cirugía , CaraRESUMEN
INTRODUCTION: Neurosurgeons must master microanatomy and its variants that occur at the skull base. To the best of our knowledge, we describe a previously unreported dural venous sinus (DVS) within the anterior petroclinoid fold and discuss its potential surgical relevance. METHODS: Fifteen latex-injected human cadaveric heads (30 sides) underwent skull base dissection using a surgical microscope. The anterior petroclinoid fold was opened in search of evidence of an embedded DVS. When identified, this sinus was documented, photographed, and measured with microcalipers. RESULTS: An anterior petroclinoid sinus (APCS) was identified in 67% of sides. These DVSs had a mean diameter of 0.65 mm and a length ranging from 8 to 15 mm (mean: 12.5 mm). The APCS ran from the anterior aspect of the cavernous sinus, arising just lateral (60%), posterior (20%), or medial (20%) to the anterior clinoid process, to the superior petrosal sinus (65%) or the posterior aspect of the cavernous sinus (35%), at the level of the posterior clinoid process. Along the course of the APCS, the oculomotor nerve was located medially at the oculomotor porus. Although slightly more common and larger on the right side, there was no statistically significant side difference. CONCLUSIONS: An improved knowledge of variant DVSs can lower the risk of intraoperative complications and increase our understanding of the venous outflow from the cavernous sinus. Future neuroimaging techniques might also seek to identify the APCS. This is the first description of a DVS contained within the anterior petroclinoid fold.
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Seno Cavernoso , Base del Cráneo , Humanos , Base del Cráneo/diagnóstico por imagen , Base del Cráneo/cirugía , Base del Cráneo/anatomía & histología , Senos Craneales/diagnóstico por imagen , Senos Craneales/cirugía , Nervio Oculomotor , Hueso Esfenoides/anatomía & histología , Seno Cavernoso/cirugía , CadáverRESUMEN
The foramen ovale (FO) of the sphenoid bone is clinically important for the interventional treatment of trigeminal neuralgia. Percutaneous procedures applied to treat the chronic pain condition typically involve the cannulation of this oval-like foramen located at the base of the skull. Anatomic variations of the FO have been reported to contribute to difficulties in the cannulation of this structure. Computed tomography (CT) can help the surgeon improve the accuracy and safety of the intervention. However, even with navigation technology, unsuccessful cannulation of the FO has been reported. The aim of this observational anatomic study was to define morphometric and morphologic data of the FO and to investigate for potential differences between measurements taken on dried human crania and digitized measurements of the FO measured on CT images. One hundred eighteen FOs were evaluated. Twenty FOs underwent CT scanning. The mean length of the foramen was 7.41±1.3 mm on the left side and 7.57±1.07 mm on the right. The mean width of the foramen was 4.63±0.86 mm on the left side and 4.33±0.99 on the right. The mean area on the left side was 27.11±7.58 and 25.73±6.64 mm 2 on the right. No significant left-right differences were found for any of these dimensions. The most important conclusion that we can draw is that the measurements can indeed be performed on CT images to obtain an accurate picture of the morphology. Considering the surgical importance of the FO and taking into consideration the limitations this study added to scientific knowledge, this study was constructive as far as neurosurgeons and anatomists are concerned.
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Foramen Oval , Neuralgia del Trigémino , Humanos , Foramen Oval/diagnóstico por imagen , Foramen Oval/cirugía , Tomografía Computarizada por Rayos X/métodos , Hueso Esfenoides/diagnóstico por imagen , Hueso Esfenoides/anatomía & histología , Cateterismo/métodos , Neuralgia del Trigémino/diagnóstico por imagen , Neuralgia del Trigémino/cirugíaRESUMEN
BACKGROUND: The dural fold between anterior and middle clinoid processes on mineralisation leads to the formation of caroticoclinoid foramen (CCF). Different morphology of this foramen presents with different clinical features. The present study reports the frequency of CCF in the population of Bihar, while providing an account of assimilated information from previous literature regarding the association of caroticoclinoid ligament ossification with age and human genetics. MATERIALS AND METHODS: The study was conducted on 100 adult dry human skulls of unknown age and sex, and 50 lateral view radiographs of the head. RESULTS: Of the 100 dry skull bones, 9 presented with different forms of CCF. Bilateral complete foramina were noticed in 2 (2%) skull bones, while the incomplete foramina were observed bilaterally in 3 (3%) and unilaterally in 4 (4%) skulls. The lateral view radiograph data (n = 50) presented with a bilateral foramen in one subject and unilateral complete CCF in two different subjects. On measurements of the diameters of the complete CCF the mean values observed were 4.06 mm and 4.51 mm on the right side, while that on the left side were 5.15 mm and 4.14 mm. For the incomplete foramina, the mean values for the vertical diameter were 4.48 mm on the right and 4.19 mm on the left side, respectively. CONCLUSIONS: The frequency of CCF in the present study population of Bihar was much lesser than that of previously studied populations. However, the variation in frequency of different morphological types of CCF was observed to be the same across populations. The variations in CCF's metric data could help in predicting the morphological changes it causes to the clinoidal segment of the internal carotid artery, as well as in distinguishing its varieties.
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Arteria Carótida Interna , Hueso Esfenoides , Adulto , Humanos , Hueso Esfenoides/anatomía & histología , Arteria Carótida Interna/anatomía & histología , Radiografía , Calcificación FisiológicaRESUMEN
The paper presents an anatomical study involving rare variations in the pterygospinous bridges found in Mongolian skulls. These structures extend between the lateral pterygoid plate and the sphenoid spine. Particularly interesting is the division of these bridges into two distinct parts of the similar length. The junctions within these structures resemble morphological patterns characteristic for the plain and zigzag sutures, which articulate the cranial bones.
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Ligamentos , Hueso Esfenoides , Humanos , Ligamentos/anatomía & histología , Hueso Esfenoides/anatomía & histología , SuturasRESUMEN
Background and Objectives: The spinous foramen (FS) of the skull is an opening located in the greater wing of the sphenoid bone at the base of the skull, and it includes the middle meningeal vessels and the meningeal branch of the mandibular trigeminal nerve. The FS is commonly used as an anatomical landmark in neurosurgical procedures and neuroimaging of the middle cranial fossa because of its relationship with other cranial foramina and surrounding vascular and nervous structures. Thus, specific knowledge of its topography and possible anatomical variations is important regarding some surgical interventions and skull imaging. The aim of this study was to provide further details on the morphology of the FS of the skull by evaluating its topographic and morphometric relationships and correlating the findings with clinical practice. Materials and Methods: Thirty dried skulls of human skeletons from body donors from the collection of the Laboratory of Anatomical Microdissection at a medical school were used. The metric dimensions and variations of the FS and its relationship with adjacent bone structures were analyzed with an interface digital microscope. Results: The results showed the bilateral presence of the FS in all skulls; however, differences were observed in the shape, diameter, and topography in relation to the foramen ovale and the spine of the sphenoid. The FS was present in the greater wing of the sphenoid bone; however, in one skull, it was located in the lateral lamina of the pterygoid process. The FS was smaller than the foramen ovale. A round and oval FS shape was the most common (42.1% and 32.8% of the samples, respectively), followed by drop-shaped (12.5%) and irregular-shaped (12.5%) foramina. Conclusions: In conclusion, FS variations among individuals are common and must be considered by surgeons during skull base interventions in order to avoid accidents and postoperative complications.