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1.
World Neurosurg ; 133: 260-265, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31605847

RESUMO

BACKGROUND: Coexistence of sinonasal and skull base tumors is uncommon but possible, and the endonasal route seems to be the best option to manage both lesions simultaneously. We report the first case in the English literature of concomitant sphenoid sinus inverted papilloma and pituitary macroadenoma treated through an endoscopic endonasal approach. CASE DESCRIPTION: A 68-year-old man presented with a history of progressive visual loss and nasal obstruction. Clinical examination disclosed bitemporal hemianopsia. Computed tomography scan and magnetic resonance imaging obtained on admission showed a large sellar/suprasellar enhancing lesion with a marked mass effect on the optic chiasm. Imaging also showed a second mass extending from the sphenoid sinus to the left nasal cavity with obstruction of the maxillary sinus ostium and development of maxillary sinus mucocele. Both tumors were entirely resected by an endoscopic endonasal approach. Additionally, middle meatal antrostomy and marsupialization with drainage of the maxillary mucocele was performed. Biopsy confirmed the coexistence of a pituitary macroadenoma and sphenoid sinus inverted papilloma. CONCLUSIONS: This case and the literature suggest that patients with concomitant nasal and skull base pathologies can be simultaneously managed. The otolaryngologist plays an essential role in removing the sinonasal lesion to ensure a safe surgical corridor before entering the intracranial cavity and for planning for the skull base reconstruction.


Assuntos
Adenoma/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Papiloma Invertido/cirurgia , Neoplasias dos Seios Paranasais/cirurgia , Neoplasias Hipofisárias/cirurgia , Seio Esfenoidal/cirurgia , Adenoma/diagnóstico por imagem , Adenoma/patologia , Idoso , Humanos , Imagem por Ressonância Magnética , Masculino , Cirurgia Endoscópica por Orifício Natural/métodos , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Primárias Múltiplas/patologia , Neuroendoscopia/métodos , Papiloma Invertido/diagnóstico por imagem , Papiloma Invertido/patologia , Neoplasias dos Seios Paranasais/diagnóstico por imagem , Neoplasias dos Seios Paranasais/patologia , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/patologia , Seio Esfenoidal/diagnóstico por imagem , Seio Esfenoidal/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
2.
Rhinology ; 57(6): 444-450, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31840148

RESUMO

BACKGROUND: The aims of this study were to propose a novel and uniï¬ed classiï¬cation system of the optico-carotid recess (OCR) and anterior clinoid process (ACP) pneumatization, determine their frequency in a Caucasian population and measure the size of the OCR. METHODOLOGY: A total of 200 specimen (400 sphenoid sinuses) were evaluated in a separate anatomic cadaveric study (n=100) and radiologic study (n=100) by using sphenoidal sinus cast and computed tomography (CT) scan. OCR was divided according to its location to the optic nerve into sub-optical and latero-optical OCR grade I-III. RESULTS: An OCR was found in 39% of the samples (78/200) and in 19% (38/200) it occurred bilaterally. Both, sub-optical and latero-optical OCR were identiï¬ed in 14% of the sides (58/400), with a mean length and depth of 6.9 mm; 7.7 mm and 2.3 mm, 7.1 mm, respectively. We determined the pneumatized ACP frequency with 23% (46/200) and deï¬ned 3 uniï¬ed different types of pneumatization. CONCLUSIONS: The OCR is a reliable landmark to identify the optico-carotid region in endoscopic sphenoid sinus surgery, and can even be visualized by CT. Hence, preoperative investigation of the sphenoid region is mandatory. In our opinion, the classiï¬cation presented in this study can be useful in order to avoid surgical complications.


Assuntos
Nervo Óptico/diagnóstico por imagem , Base do Crânio/anatomia & histologia , Base do Crânio/diagnóstico por imagem , Seio Esfenoidal/anatomia & histologia , Seio Esfenoidal/diagnóstico por imagem , Cadáver , Humanos , Modelos Anatômicos , Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Nervo Óptico/anatomia & histologia , Base do Crânio/cirurgia , Osso Esfenoide/anatomia & histologia , Osso Esfenoide/diagnóstico por imagem , Osso Esfenoide/cirurgia , Seio Esfenoidal/cirurgia , Tomografia Computadorizada por Raios X
3.
J Craniofac Surg ; 30(5): 1605-1608, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31299779

RESUMO

This retrospective study aimed to assess the association of the volume and types of the sphenoid sinus with deviated nasal septum by analyzing multislice computed tomography images. A total of 93 patients with a deviated nasal septum and 70 healthy controls were included in the study. Patients with sinonasal morbidities other than deviation were excluded. Three-dimensionally reconstructed computed tomography images of the study participants were acquired. A total of 326 sphenoid sinus volumes from the patient and control groups were obtained and compared between the groups. Sphenoid sinus volumes and the angle of the deviation were measured for standardization and assessment of the severity. Deviated nasal septum was found on the right in 49.5% (n = 46) and on the left in 50.5% (n = 47) of the study participants. Deviation angles were in the range from 7.2° to 22.4° and the mean value was 13.2°â€Š±â€Š5.0°. The measured volumes were in the range from 1.8 cm to 9.6 cm with a mean of 4.8 ±â€Š1.5 cm. In the control group, the median values for the sphenoid sinus volumes were 4.40 cm (0.80-8.90 cm) on the right and 4.20 cm (0.90-8.70 cm) on the left. In the study group, sphenoid sinus volumes were found to be statistically significantly different between those on the ipsilateral and contralateral side of the septal deviation. Sphenoid sinus volumes were significantly smaller on the same side with septal deviation compared with those on the contralateral side. There was no statistical relationship between the presence of septal deviation, age and gender, and the type of sphenoid sinus.


Assuntos
Septo Nasal/diagnóstico por imagem , Deformidades Adquiridas Nasais/diagnóstico por imagem , Seio Esfenoidal/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Estudos Retrospectivos , Adulto Jovem
4.
Eur Arch Otorhinolaryngol ; 276(10): 2887-2894, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31302743

RESUMO

PURPOSE: We aimed to determine the position and size of the sphenoid sinus (SS) in our study and compare the results of the measurements relative to age, gender, and the presence of pituitary adenoma using multidetector computerized tomography (MDCT). METHODS: We retrospectively evaluated the paranasal sinus computerized tomography (CT) images of 200 individuals (age range of all the individuals 4-84 years; 101 females, 99 males; age range of individuals with pituitary adenoma 15-63 years; 15 females, 9 males) with 24 pituitary adenomas. The shape of SS were identified and classified, volume were measured by MDCT also for individuals with pituitary adenoma. RESULTS: It was determined that the volume averages were significantly affected by the type of SS. Among all the individuals studied, the sellar type of SS was most frequently observed (41.5%), followed by the postsellar type (38.5%), and the least observed was the presellar type (9%). The volume of the SS is bigger in males than females although the volume is not affected by the presence of pituitary adenomas. The development of the SS continues until the age of nine. CONCLUSION: The morphology and morphometry of the SS show individual differences. These anatomic variations are important for decision making and application for surgical interventions (especially transsphenoidal surgery).


Assuntos
Adenoma/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Neoplasias Hipofisárias/diagnóstico por imagem , Seio Esfenoidal , Adolescente , Adulto , Fatores Etários , Idoso de 80 Anos ou mais , Análise de Variância , Pré-Escolar , Classificação , Feminino , Humanos , Masculino , Tamanho do Órgão , Estudos Retrospectivos , Fatores Sexuais , Seio Esfenoidal/diagnóstico por imagem , Seio Esfenoidal/patologia , Seio Esfenoidal/cirurgia
5.
J Craniofac Surg ; 30(4): e300-e301, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31166272

RESUMO

Odontoma is the most common mixed epithelial and mesenchymal tumour-like malformation which affects maxillary bones. Clinically, Odontomas present as lesions of benign behavior, causing little or no deformity, are asymptomatic, with self-limited growth and usually detected on routine radiographs. Radiographically, they are radiopaque lesions, well-demarcated surrounded by a thin soft tissue capsule. Compound odontomas consist of numerous tooth-like structures, whereas in complex odontomas it consists of a disorganized mass of calcified tissue. The aim of this article was to report an atypical case of intracranial compound odontoma, in the middle cranial fossa, reaching the sphenoidal sinus, which has been followed for 10 years.


Assuntos
Odontoma/diagnóstico por imagem , Neoplasias da Base do Crânio/diagnóstico por imagem , Adulto , Assistência ao Convalescente , Tomografia Computadorizada de Feixe Cônico , Fossa Craniana Média/diagnóstico por imagem , Feminino , Humanos , Seio Esfenoidal/diagnóstico por imagem
6.
Surg Radiol Anat ; 41(9): 1011-1018, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31250138

RESUMO

OBJECTIVE: The aim of this study was to investigate the anatomical imaging characteristics of posterior ethmoid cells (PEs) expanding towards the inferolateral region of the sphenoid sinus (SS). METHODS: This study included a total of 278 inpatients (556 sides) whose paranasal sinus computed tomography (CT) scans were reviewed and collected from May 2018 to February 2019. The anatomical imaging characteristics of PEs expanding towards the inferolateral region of the SS were observed. RESULTS: PEs expanding towards the inferolateral region of the SS formed an inferolateral spheno-ethmoid cell (ISEC). ISECs were observed on three sides (0.54%; 3/556) in three cases (1.08%; 3/278). All of the ISECs were present unilaterally on the right side of the SS. The ISECs originated from the most posterior ethmoid cell; they were first located at the medial aspect of the orbital apex, pneumatized continually backward to the inferomedial wall of the orbital apex, and then extended into the lateral region of the SS. The ISECs further extended laterally, inferiorly and posteriorly beyond the sphenoid body into the greater wing and/or pterygoid process. CONCLUSION: An ISEC is a rare variation of ethmoid air cells. Preoperative recognition of ISECs is essential to achieve safe and effective endoscopic sinus surgery because of the important anatomical location.


Assuntos
Variação Anatômica , Seio Etmoidal/anatomia & histologia , Seio Esfenoidal/anatomia & histologia , Adolescente , Adulto , Idoso , Seio Etmoidal/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Seio Esfenoidal/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto Jovem
7.
Aerosp Med Hum Perform ; 90(6): 566-569, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31101142

RESUMO

BACKGROUND: Pneumocephalus is intracranial air normally occurring as a consequence of trauma or cranial surgery, but rarely has been reported following the habitual use of the Valsalva maneuver. We were unable to locate any similar cases of pneumocephalus associated with high performance aircraft flight, and this case report highlights an important consequence of the inappropriate use of Valsalva on ascent to altitude.CASE REPORT: A healthy 29-yr-old F-22 instructor pilot presented with recurrent pneumocephalus following the use of the Valsalva maneuver. These episodes started after an initial use of a forceful Valsalva during an aggressive unrestricted climb to altitude. His symptoms included facial pressure and a bubbling sensation in his head followed by a severe headache for several days. After upright CT evaluation, three small sphenoid sinus defects were discovered and repaired. There was no recurrence of pneumocephalus following provocative testing after surgical repair of the sphenoid sinus defects, and the aviator returned to flying high performance aircraft.DISCUSSION: Spontaneous or Valsalva-associated pneumocephalus is an uncommon occurrence in healthy individuals. Awareness of the pathognomonic succussion splash associated with this diagnosis as well as a presentation of facial pressure and headache following flight will lead to appropriate diagnostic investigation and management. This case highlights the importance of recognizing rare diagnoses like pneumocephalus in the flying population, and future education of aerospace physiology technicians and aviators should emphasize appropriate Valsalva technique to promote flying safety and prevent similar presentations.Woodside SS, Metzler MM. Pneumocephalus associated with inappropriate Valsalva technique. Aerosp Med Hum Perform. 2019; 90(6):566-569.


Assuntos
Transtornos da Cefaleia Primários/etiologia , Pneumocefalia/etiologia , Manobra de Valsalva , Medicina Aeroespacial , Altitude , Transtornos da Cefaleia Primários/diagnóstico por imagem , Voluntários Saudáveis , Humanos , Masculino , Pilotos , Pneumocefalia/diagnóstico por imagem , Recidiva , Seio Esfenoidal/diagnóstico por imagem
8.
World Neurosurg ; 128: 452-453, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31108253

RESUMO

A 53-year-old man presented with a 1-week history of headache and double vision. On examination, he was found to have right cranial nerve III palsy. Computed tomography and magnetic resonance imaging of the brain showed a sellar mass with right cavernous sinus invasion. There was no evidence of anterior visual pathway compression on formal neuro-ophthalmologic examination. An elective endoscopic transsphenoidal adenectomy was performed. On access to the sphenoid sinus, he was noted to have a completely dehiscent posterior bony wall of sphenoid sinus with only a thin mucous membrane covering the sella, optic nerves, carotid arteries, and clivus (Figure 1). A focal area of mucosa was subsequently stripped from the posterior sphenoid sinus wall, and a micro-Doppler was used to localize the carotid arteries before sharp dural opening. The tumor was subsequently resected without complication. Failure to appreciate this uncommon anatomic variant (Figures 2 and 3) could result in disastrous irreversible carotid artery or optic nerve injury.


Assuntos
Adenoma/cirurgia , Neuroendoscopia/métodos , Neoplasias Hipofisárias/cirurgia , Seio Esfenoidal/anormalidades , Variação Anatômica , Artérias Carótidas/anatomia & histologia , Humanos , Masculino , Pessoa de Meia-Idade , Nervo Óptico/anatomia & histologia , Seio Esfenoidal/diagnóstico por imagem , Tomografia Computadorizada por Raios X
9.
Ear Nose Throat J ; 98(7): 425-430, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31012343

RESUMO

In this article, we explore the disease spectrum and clinical characteristics of and the diagnosis and endoscopic approach to treating isolated sphenoid sinus disease (ISSD) in children. To these ends, we review a case series of 19 patients (mean age: 8.1 ± 4.9 years, range: 1.1-15 years, median age: 6.7 years, 13 males, 6 females) who underwent surgical treatment at our hospital for ISSD during the 4 years between 2012 and 2016. The symptoms of pediatric sphenoid sinus disease tend to be variable and nonspecific and include atypical headache, nasal congestion, epistaxis, postnasal drip, snoring, and impaired vision. Headache is the presenting symptom in 42% of patients, but headaches occurred in no specific or typical location. Ten patients underwent preoperative endoscopic examination, and abnormalities in the sphenoethmoidal recess were found in 6 (60%) of these 10 patients. All 19 patients underwent ultra-low-dose paranasal sinus computed tomography (CT) imaging, and 9 patients with suspected tumors or sphenoid mucoceles were further examined by magnetic resonance imaging (MRI). The endoscopic transostial approach was performed in all 19 patients: 16 patients received excision of inflammatory sphenoid sinus disorders and benign tumors, including sphenoid sinusitis, sphenoid sinus mucocele, sphenoid sinus polyp, and ossifying fibroma; 3 patients with suspected tumors received biopsies to detect rhabdomyosarcoma, Langerhans cell histiocytosis, and juvenile xanthogranuloma. No intraoperative or immediate postoperative complications were observed. Children with opacified sphenoid sinus identified by radiographic imaging presented a variety of pathologies. The most common lesions were associated with inflammatory disease. Because the symptoms of pediatric sphenoid sinus disease tend to be variable and nonspecific, CT remains the standard for evaluating sphenoid sinus disease, and ultra-low-dose paranasal sinus CT imaging is recommended and can provide images of equal or better quality compared with those obtained by standard dose CT. In addition, MRI is an essential adjunct in the diagnosis and selection of treatment for suspected tumors of the sphenoid sinus. The endoscopic transostial approach was especially suitable for the management of pediatric benign isolated sphenoid sinus lesions.


Assuntos
Endoscopia/métodos , Doenças dos Seios Paranasais/cirurgia , Seio Esfenoidal/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Imagem por Ressonância Magnética , Masculino , Mucocele/diagnóstico por imagem , Mucocele/cirurgia , Pólipos Nasais/diagnóstico por imagem , Pólipos Nasais/cirurgia , Doenças dos Seios Paranasais/diagnóstico por imagem , Neoplasias dos Seios Paranasais/diagnóstico por imagem , Neoplasias dos Seios Paranasais/cirurgia , Seio Esfenoidal/diagnóstico por imagem , Sinusite Esfenoidal/diagnóstico por imagem , Sinusite Esfenoidal/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
10.
J Laryngol Otol ; 133(6): 482-486, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30967162

RESUMO

OBJECTIVE: To report the prevalence of different anatomical variations of the sphenoid sinus and its related structures among paediatric patients with or without chronic rhinosinusitis. METHODS: Computed tomography scans of 50 paediatric patients with chronic rhinosinusitis were reviewed and compared to 50 scans of paediatric patients without chronic rhinosinusitis. The type of sphenoid sinus pneumatisation and the surrounding structures were thoroughly analysed. The patients were divided into three groups according to age. RESULTS: Mean age was 10.9 years (range, 4-16 years). The sellar configuration was the commonest in all groups, while the conchal type was the least common. There were significant differences between paediatric patients with or without sinusitis in: sphenoid sinus pneumatisation type, vidian canal type and Onodi cell presence. In addition, there were significant differences between age groups in: sphenoid sinus pneumatisation type, single sinus septum and multiple septa presence, and internal carotid artery bulging. CONCLUSION: Age and sinusitis have a significant impact on sphenoid pneumatisation type and surrounding structure variation. Recognition of these variations can be useful for mapping this region, and enables a safer and more efficient endoscopic surgical procedure.


Assuntos
Sinusite/diagnóstico por imagem , Seio Esfenoidal/anatomia & histologia , Seio Esfenoidal/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adolescente , Fatores Etários , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Doença Crônica , Humanos , Masculino , Procedimentos Cirúrgicos Nasais/métodos , Cuidados Pré-Operatórios/métodos , Prognóstico , Valores de Referência , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Sinusite/cirurgia , Seio Esfenoidal/cirurgia , Resultado do Tratamento
12.
J Med Case Rep ; 13(1): 62, 2019 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-30832738

RESUMO

BACKGROUND: Basal meningoceles are rare herniations of the meninges that tend to present unilaterally with cerebrospinal fluid rhinorrhea. Growing evidence suggests that intracranial hypertension contributes considerably to the formation of spontaneous basal meningoceles. CASE PRESENTATION: A 50-year-old man of Middle East ethnicity presented with a 16-week history of cerebrospinal fluid rhinorrhea, short-term memory loss, and slight decline in cognitive function. We present a case of bilateral spontaneous meningoceles with bone defects in the left lateral sphenoid sinus and right anterior cribriform plate, as well as with a remodeled sella. A neuronavigation-assisted expanded endoscopic endonasal surgery was performed to resect the meningoceles. Postoperative imaging demonstrated complete resolution of the bilateral meningoceles. CONCLUSIONS: This case reports the first bilateral basal spontaneous meningoceles in the literature. Furthermore, based on this case's imaging results and the literature reviewed, elevated intracranial pressure may be a determining factor behind the development of spontaneous meningoceles.


Assuntos
Rinorreia de Líquido Cefalorraquidiano/patologia , Meningocele/diagnóstico por imagem , Seio Esfenoidal/patologia , Rinorreia de Líquido Cefalorraquidiano/etiologia , Rinorreia de Líquido Cefalorraquidiano/cirurgia , Disfunção Cognitiva/etiologia , Endoscopia , Humanos , Masculino , Transtornos da Memória/etiologia , Meningocele/patologia , Meningocele/cirurgia , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Seio Esfenoidal/diagnóstico por imagem , Seio Esfenoidal/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
14.
Ann Otol Rhinol Laryngol ; 128(7): 676-680, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30873845

RESUMO

OBJECTIVE: SMARCB1-deficient sinonasal tract carcinomas are an emerging subset of rare tumors recently described in the literature, with less than 100 reported cases. Given the aggressive nature of this tumor, timely diagnosis is especially important. We present a case report of a SMARCB1-deficient carcinoma of the sinonasal tract. METHODS: Case report with review of the literature. RESULTS: The patient was a 53-year-old male with computed tomography (CT)-proven mass of the right ethmoid and sphenoid sinuses. Rigid nasal endoscopy revealed a purple mass completely obstructing the right nasal cavity that extended inferiorly from the posterior ethmoids and sphenoid sinuses. Initial biopsy in the emergency room was nondiagnostic due to extensive tumor necrosis. Magnetic resonance imaging (MRI) revealed T2 hypointense enhancing mass centered in the right posterior ethmoids with invasion into the right orbital apex, classifying it as a T4b tumor. The patient underwent repeat biopsy with frozen section and tumor debulking. Immunohistochemical analysis of subsequent biopsy revealed complete loss of INI-1 and negative staining for other pertinent markers, alluding to the diagnosis of SMARCB1-deficient sinonasal tract carcinoma. CONCLUSION: Tumor necrosis may be problematic in obtaining a diagnosis for SMARCB1-deficient sinonasal carcinomas. Thus, sampling various regions of the tumor during initial biopsy can prevent delays in diagnosis and treatment.


Assuntos
Carcinoma/metabolismo , Seio Etmoidal/diagnóstico por imagem , Neoplasias dos Seios Paranasais/metabolismo , Proteína SMARCB1/metabolismo , Seio Esfenoidal/diagnóstico por imagem , Biomarcadores Tumorais/metabolismo , Carcinoma/diagnóstico por imagem , Carcinoma/patologia , Carcinoma/cirurgia , Procedimentos Cirúrgicos de Citorredução , Seio Etmoidal/patologia , Seio Etmoidal/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Neoplasias dos Seios Paranasais/diagnóstico por imagem , Neoplasias dos Seios Paranasais/patologia , Neoplasias dos Seios Paranasais/cirurgia , Seio Esfenoidal/patologia , Seio Esfenoidal/cirurgia , Tomografia Computadorizada por Raios X
15.
Eur Arch Otorhinolaryngol ; 276(5): 1373-1383, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30747319

RESUMO

INTRODUCTION: The aim of this study is to explore the anatomy of the Vidian nerve to elucidate the appropriate surgical approach based on preoperative cone-beam computed tomography (CBCT) images. MATERIALS AND METHODS: The Vidian canal and its surrounding structures were morphometrically evaluated retrospectively in CBCT images of 400 cases by the Planmeca Romexis program. The types of the Vidian canal were determined and seven parameters were measured from the images. RESULTS: Three types of the Vidian canal according to the relationship with the sphenoid bone were found as follows: the Vidian canal totally protruded into the sphenoid sinus (19.75%), partially protruded into sphenoid sinus (44.37%) and embedded inside bony tissue of the body of sphenoid bone (35.87%). The position of the Vidian canal was medial (34.62%), on the same line (55.12%) and lateral (10.25%) to the medial plate of the pterygoid process. The distance between the Vidian canal and the vomerine crest, the mid-sagittal plane, the round foramen, the palatovaginal canal, and the superior wall of the sphenoid sinus, the length of the Vidian canal and the angle between the Vidian canal and the sagittal plane was found to be 16.69 ± 2.14, 13.80 ± 2.00, 8.88 ± 1.60, 5.83 ± 1.37, 23.98 ± 2.68, 13.29 ± 1.71 mm and 25.78° ± 3.68° in males, 14.62 ± 1.66, 11.43 ± 1.28, 8.51 ± 1.63, 5.78 ± 0.57, 22.37 ± 2.07, 12.91 ± 1.26 mm and 23.43° ± 3.07° in females, respectively. CONCLUSIONS: Our results may assist with proper treatment for surgical procedures around the Vidian canal with a high success rate and minimal complications. Therefore, the results obtained in this study contribute to the literature.


Assuntos
Tomografia Computadorizada de Feixe Cônico/métodos , Meato Acústico Externo , Gânglio Geniculado/anatomia & histologia , Processo Mastoide , Osso Esfenoide/diagnóstico por imagem , Seio Esfenoidal , Adulto , Meato Acústico Externo/anatomia & histologia , Meato Acústico Externo/diagnóstico por imagem , Meato Acústico Externo/inervação , Feminino , Humanos , Complicações Intraoperatórias/prevenção & controle , Masculino , Processo Mastoide/diagnóstico por imagem , Processo Mastoide/inervação , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Otorrinolaringológicos/efeitos adversos , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Cuidados Pré-Operatórios/métodos , Seio Esfenoidal/diagnóstico por imagem , Seio Esfenoidal/inervação
16.
Surg Radiol Anat ; 41(5): 507-512, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30739148

RESUMO

PURPOSE: Anatomy of sphenoid sinuses has acquired a growing importance with the diffusion of transsphenoidal surgical procedures. A common risk in these practices is the damage of internal carotid artery (ICA) and optic nerve (ON), which may protrude into the sphenoid air cavities. This study aims at analysing the relationships between sphenoid sinuses volume and protrusion of ICA and ON. METHODS: 260 head CT-scans were retrospectively analysed (equally divided among males and females, age range 20-92 years). Volume was segmented through ITK-SNAP software. In addition, the subjects were classified into four groups: no protrusion of any structure (group 1), protrusion of ICA (group 2), protrusion of ON (group 3), protrusion of both ICA and ON (group 4). Possible statistically significant differences in prevalence of the four groups according to gender were assessed through Chi-squared test (p < 0.05). Differences in volume between the four groups were assessed through one-way ANOVA test (p < 0.05), separately for males and females. RESULTS: Group 1 was the most frequent (40.0%), followed by group 4 (27.7%) and group 2 (18.5%), without any difference according to gender. For what concerns volume, cases of ICA and concomitant ICA + ON protrusion had significantly larger sinuses, whereas isolated ON protrusion did not modify sinus volume. CONCLUSIONS: Results show that protrusion of ICA is positively related with the volume of sphenoid sinuses, whereas the same relation was not verified for ON: surgeons should accurately consider possible ON protrusion in each case, as it may occur independently from sphenoid sinuses volume.


Assuntos
Artéria Carótida Interna/anatomia & histologia , Artéria Carótida Interna/diagnóstico por imagem , Imagem Tridimensional , Nervo Óptico/anatomia & histologia , Nervo Óptico/diagnóstico por imagem , Seio Esfenoidal/anatomia & histologia , Seio Esfenoidal/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Pontos de Referência Anatômicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
18.
Eur Arch Otorhinolaryngol ; 276(4): 1057-1064, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30617426

RESUMO

OBJECTIVES: We investigated the relationship between Onodi cells and optic canal by paranasal sinus computed tomography (PNSCT). METHODS: In this retrospective study, 508 PNSCT (265 males and 243 females) was examined. Onodi cell presence, pneumatization types, optic canal types; and also sphenoid sinusitis and anterior clinoid process pneumatization were evaluated. RESULTS: The prevalence of Onodi cells was 21.2% of the patients. Onodi cells were observed 40.7% on the right side and 25.9% on the left side. In 33.4% of the patients, bilateral Onodi cells were present. Male/Female ratio was 24.5%/17.6%. Onodi cell types were detected as Type I > Type II > Type III bilaterally. There was a positive correlation between the right and left Onodi cell types (p < 0.05). Optic canal types were detected as Type IV > Type I > Type II > Type III. bilaterally. There was a positive correlation between right and left optic canal types. Onodi cell presence and ACP pneumatization were found as statistically significant (p < 0.05). In 65.5% of the patients, Onodi cells and ACP pneumatization were absent. ACP pneumatization was present in 35.4% of the cases. In nine cases, bilateral Onodi cells and ACP pneumatization were detected. Sphenoid sinusitis was detected in 11.4% of Type I and 13.8% of the Type II Onodi cells on the right side. On the left side, it was detected in 12.9% of the Type I and 19.0% of Type II Onodi cells. CONCLUSION: Identification of Onodi cell is very important clinically because of its proximity to optic nerve canal. We concluded that type IV Onodi-optic canal relationship was the most common finding in our study. Onodi cell presence and their patterns of pneumatization must be evaluated on PNSCT preoperatively to avoid optic canal damage.


Assuntos
Nervo Óptico/diagnóstico por imagem , Seios Paranasais , Osso Esfenoide , Seio Esfenoidal , Sinusite Esfenoidal/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Osso Etmoide/diagnóstico por imagem , Osso Etmoide/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seios Paranasais/diagnóstico por imagem , Seios Paranasais/patologia , Prevalência , Estudos Retrospectivos , Osso Esfenoide/diagnóstico por imagem , Osso Esfenoide/patologia , Seio Esfenoidal/diagnóstico por imagem , Seio Esfenoidal/patologia
19.
Neurosurg Rev ; 42(2): 519-529, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29926302

RESUMO

In the present study, we investigated the relationship between sphenoid sinus, carotid canal, and optic canal on paranasal sinus computed tomography (PNSCT). This study was performed retrospectively. PNSCT images of 300 adult subjects (159 male, 141 female). Sphenoid sinus (pneumatisation, dominancy, septation, inter-sinus septa deviation), anterior clinoid process pneumatisation, Onodi cell, carotid and optic canals (width, dehiscence, classification) were measured. In males, type 3 pneumatised sphenoid sinus (in both sides) and in females type 2 pneumatised sphenoid sinus (right side) and type 3 pneumatised sphenoid sinus (left side) were detected more. Anterior clinoid pneumatisation was present 47.2% in males and 39.7% in females. In male group, more septation (i.e. 22.6%, ≥ 3 septa) in sphenoid sinus were detected. Onodi cell was present 26.6 and 19.1% in males and females, respectively. Carotid canal protrudation to the sphenoid sinus wall was present 23.9-32.1% in males and 35.5-36.2% in females. Dehiscence in carotid canal was detected more in females (34%) compared to males (22%). Optic canal protrudation was 33.3 and 30.5% in males and females. Type 4 optic canal was detected more in both gender. Optic canal dehiscence was detected 11.3 and 9.9% in males and females. Carotid and optic canal diameters were higher in males. In pneumatised sphenoid sinuses and in females, type 3 carotid canal (Protrudation to SS wall) (bilaterally) and type 1 optic canal type (No indentation) (ipsilateral side) were detected more. In elderly patients, carotid and optic canal width increased. When carotid canal protrudation was detected, there was no indentation in optic canals In pneumatised SS, carotid canal protrudation was observed with a greater risk in surgery. However, type 1 (non indentation) optic canal was present in highly pneumatised SS with lower risk for the surgery. In women, the risk of carotid canal protruding (about 1/3) is greater than that of males, and carotid canal dehiscence rates are also higher in females. Therefore, physicians should be very careful during the preparatory stages of the sphenoid sinus surgery. Otherwise, it may not be possible to prevent lethal carotid artery bleeds.


Assuntos
Seio Carotídeo/anormalidades , Osso Esfenoide/anormalidades , Seio Esfenoidal/anormalidades , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Seio Carotídeo/diagnóstico por imagem , Fossa Craniana Posterior/anormalidades , Fossa Craniana Posterior/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais , Osso Esfenoide/diagnóstico por imagem , Seio Esfenoidal/diagnóstico por imagem , Seio Esfenoidal/cirurgia , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem
20.
World Neurosurg ; 121: e140-e146, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30240854

RESUMO

OBJECTIVE: To investigate key anatomic features of the vidian canal that have a critical role in planning and performing endoscopic skull base surgeries. METHODS: We reviewed skull base computed tomographic images of 640 consecutive subjects. Studies were analyzed in axial, coronal and sagittal planes. RESULTS: The mean (±SD) length of the vidian canal was 15.4 ± 2.0 mm in female subjects and 16.6 ± 1.7 mm in male subjects, and the difference between genders was statistically significant (P < 0.001). The most common rostral-caudal course of the vidian canal was medial to lateral and was followed by the straight course, tortuous course, and lateral-to-medial course. The frequency of pneumatization pattern from most common to least common was types 0, III, II and I. Of 342 evaluated sides, the vidian canal was located below the level of the anterior genu of petrous ICA in 303 (89%) sides, at same level with the anterior genu of petrous ICA in twenty-five(7%) sides, and above the level of the anterior genu of petrous ICA in fourteen(4.1%) sides. CONCLUSIONS: A variety of previously undefined features of the vidian canal that can alter the course of surgical procedure were defined. The position of the vidian canal with respect to the petrous internal carotid artery (ICA) was extensively described. From a surgical standpoint, a working room inferior and medial to the vidian canal might not always be a safe approach, because the vidian canal could be located superior to the level of the anterior genu of petrous ICA according to our findings in the present study.


Assuntos
Artéria Carótida Interna/anatomia & histologia , Base do Crânio/anatomia & histologia , Adolescente , Adulto , Idoso , Artéria Carótida Interna/diagnóstico por imagem , Cavidades Cranianas/anatomia & histologia , Cavidades Cranianas/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Neuroendoscopia/métodos , Procedimentos Neurocirúrgicos/métodos , Estudos Retrospectivos , Caracteres Sexuais , Base do Crânio/irrigação sanguínea , Base do Crânio/diagnóstico por imagem , Base do Crânio/cirurgia , Osso Esfenoide/anatomia & histologia , Osso Esfenoide/diagnóstico por imagem , Seio Esfenoidal/anatomia & histologia , Seio Esfenoidal/diagnóstico por imagem , Adulto Jovem
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