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Graphic representation of the anatomical location of sphenoid sinus (SS) and its relationships with the cavernous sinuses (CS), which contains many nervous structures, and in detail the optic nerve (II), the oculomotor nerve (III), the trochlear nerve (IV), the ophthalmic branch of the trigeminal nerve (V1), the abducens nerve (VI), the maxillary branch of the trigeminal nerve (V2). Anteriorly, the pituitary gland (PG) and the internal carotid artery (ICA)
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PurposeSphenoid sinuses are pneumatised structures, placed in the body of the sphenoid bone, with highly variable morphology. The strict relationships with vascular and nervous structures determine the importance of their anatomical variants in otorhinolaryngology and neurosurgery; a precise understanding of the complex anatomy and anatomic variati...
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Background: The demographic profile of patients with Sphenoiditis undergoing surgical intervention, in the state of Punjab was studied. The emphasis was on the age, gender and clinical presentation in this prospective study.Methods: There were 75 patients of sphenoethmoidal recess pathology with sphenoditis, who were selected from the Rhinology cli...
Citations
... Computed tomography (CT) is the gold standard imaging method in the evaluation of paranasal sinuses and surrounding structures [2,4,24]. Developments in the field of CT imaging have enabled a better understanding of the diagnosis-treatment process of paranasal sinus diseases and made the detection of variation more sensitive [24]. ...
... Developments in the field of CT imaging have enabled a better understanding of the diagnosis-treatment process of paranasal sinus diseases and made the detection of variation more sensitive [24]. In addition, paranasal sinuses have a complex anatomical structure and are important in planning safe surgical procedures to prevent intraoperative complications [4]. ...
Purpose
To measure the volume of the sphenoid and ethmoid sinuses and to analyse the asymmetry index values by age/gender.
Methods
Three-dimensional (3D) Computed Tomography (CT) images of 150 individuals (75 females, 75 males) of both sexes between the ages of 18–75 were included in our study. Sphenoid and ethmoid sinus volumes were measured using the 3D Slicer software package on these images, and the asymmetry index was calculated.
Results
In our study, mean sphenoid sinus volume (female right: 4264.4 mm³, left: 3787.1 mm³; male right: 5201.1 mm³, left: 4818.2 mm³) and ethmoid sinus volume (female right: 3365.1 mm³, left: 3321.2 mm³; male right: 3440.9 mm³, left: 3459.5 mm³) were measured in males and females. Left sphenoid sinus values of males were statistically higher than females (p = 0.036). No statistically significant relationship existed between age, sinus volumes, and asymmetry index (p > 0.05). A statistically weak positive correlation existed between males’ left sphenoid and ethmoid sinus volume (rho = 0.288; p = 0.012). There was no statistical relationship between asymmetry index in the whole group (p > 0.05). A statistically weak negative correlation was found between sphenoid and ethmoid sinus asymmetry index in males (rho=-0.352; p = 0.002). There was no statistical relationship between asymmetry index in females (p > 0.05).
Conclusion
Knowing paranasal sinus morphology, morphometry, and asymmetry index value will be significant for preoperative and postoperative periods.
... Prediction models, which serve as a new noninvasive diagnostic method, play an important role in addressing this challenge. Sinus computed tomography (CT) is the routine imaging examination used for CRS diagnosis and treatment planning, and CT data are often used to construct predictive models [9]. However, the Lund-Mackay (LM) scoring scale, global osteitis scoring scale (GOSS), or radiomics methods used in previous studies to quantify sinus CT data are all shallow prediction models and cannot overcome the subjective interference caused by manual extraction of the image features [8,[10][11][12][13]. ...
Background
As treatment strategies differ according to endotype, rhinologists must accurately determine the endotype in patients affected by chronic rhinosinusitis with nasal polyps (CRSwNP) for the appropriate management. In this study, we aim to construct a novel deep learning model using paranasal sinus computed tomography (CT) to predict the endotype in patients with CRSwNP.
Methods
We included patients diagnosed with CRSwNP between January 1, 2020, and April 31, 2023. The endotype of patients with CRSwNP in this study was classified as eosinophilic or non-eosinophilic. Sinus CT images (29,993 images) were retrospectively collected, including the axial, coronal, and sagittal planes, and randomly divided into training, validation, and testing sets. A residual network-18 was used to construct the deep learning model based on these images. Loss functions, accuracy functions, confusion matrices, and receiver operating characteristic curves were used to assess the predictive performance of the model. Gradient-weighted class activation mapping was performed to visualize and interpret the operating principles of the model.
Results
Among 251 included patients, 86 and 165 had eosinophilic or non-eosinophilic CRSwNP, respectively. The median (interquartile range) patient age was 49 years (37–58 years), and 153 (61.0%) were male. The deep learning model showed good discriminative performance in the training and validation sets, with areas under the curves of 0.993 and 0.966, respectively. To confirm the model generalizability, the receiver operating characteristic curve in the testing set showed good discriminative performance, with an area under the curve of 0.963. The Kappa scores of the confusion matrices in the training, validation, and testing sets were 0.985, 0.928, and 0.922, respectively. Finally, the constructed deep learning model was used to predict the endotype of all patients, resulting in an area under the curve of 0.962.
Conclusions
The deep learning model developed in this study may provide a novel noninvasive method for rhinologists to evaluate endotypes in patients with CRSwNP and help develop precise treatment strategies.
... The prevalence of pathological conditions, such as sinusitis, nasal polyps, and head tumors, emphasizes the significance of understanding the intricacies of their anatomy and pathology. In fact, the paranasal sinuses exhibit a wide range of variations (Kantarci et al. 2004;Cellina et al. 2020), and "dangerous" variants, such as the presence of Onodi's cells, Haller's cells, as well as a low placed fovea ethmoidalis are of paramount importance (Gupta et al. 2012), as anticipating and identifying these variants before surgery are crucial to avoid the risk of injury. A comprehensive understanding of the paranasal sinuses is indispensable for accurate diagnosis and effective disease management, making it a vital prerequisite for both precise diagnosis and the development of appropriate treatment strategies. ...
Since its inception, the International Anatomical Terminology has been an indispensable and widely embraced resource for authors, anatomists, researchers, and medical professionals, ensuring standardized anatomical terminology across various disciplines. Nonetheless, it is widely acknowledged that periodic updates and enhancements are necessary to incorporate the latest scientific knowledge and advancements in imaging techniques. The current version of Terminologia Anatomica includes a section dedicated to the paranasal sinuses, encompassing ethmoidal cells and three sinuses: frontal, sphenoidal, and maxillary. However, the anatomical lexicon pertaining to the paranasal sinuses is more extensive. In clinical practice, multiple terms related to clinically significant structures are commonly employed. This article focuses on the clinical terminology associated with the paranasal sinuses, proposing significant extensions to the existing Terminologia Anatomica. These extensions aim to enrich the anatomical nomenclature and facilitate a harmonious convergence between the language of clinicians and the anatomical lexicon. Further endeavors should bridge the gap in anatomical nomenclature and improve communication between anatomists, researchers, and clinicians, thereby enhancing diagnostic accuracy and improving interdisciplinary research collaboration.
... Pneumatization and expansion of the sphenoethmoidal cells are directly linked to the exposure of neurovascular structures (such as the internal carotid artery and the optic canal) during surgical procedures. 6 For instance, the optic nerve may emerge prominently on the lateral wall of these OCs and surround them. 7 Furthermore, the degree of pneumatization impairs mucus drainage and may cause sinonasal mucosal disease. 1 Much has been studied about OCs, but, to the best of our knowledge, there is no study on the impact of their volume on neurovascular structures and mucosal diseases. ...
... As this region presents the greatest anatomical variation in the human body, 1 several studies have already highlighted the importance of precisely identifying ethmoid cells, 2,4,5 particularly the OCs, also known as sphenoethmoidal air cells. 6,7 In a recent article, 8 the authors reported that OCs can have a high variability of prevalence, ranging from 1.6% to 55.8%. We can assume that the high prevalence may be associated with the fact that several different devices can be used to acquire the images, such as CT scanners, 11 cone beam CT scanners, 3 and magnetic resonance imaging scanners. ...
... The identification of OCs is very important clinically because of their proximity to the optic nerve canal. 2,6,8,12 Most authors would agree that there is a posi-tive correlation between OCs and the optic nerve. 6, 8 Chmielik and Chmielik 14 demonstrated that the wall of the optic nerve canal was in contact with at least one posterior ethmoid cell (55.6%). ...
Introduction Onodi cells (OCs) are posterior ethmoid cells that are located above the sphenoid sinus, close to or even surrounding the carotid artery and optic nerve.
Objective To investigate and evaluate the volumetric variation of OCs through multi-slice computed tomography (MSCT) scans.
Methods We performed a retrospective review of MSCT scans of 79 subjects, 40 male and 39 female patients, Whose age ranged from 18 to 83 (mean: 39.6) years. The volumes of the OCs on the right and left sides were measured using the ITK-SNAP software (open-source) with semiautomatic segmentation. The possible relationships involving age, gender, contact with the optic nerve, extension of the pneumatization of the posterior ethmoid cells into the clinoid processes, mucous thickening in the anterior and posterior ethmoid cells, and obliteration of the sphenoethmoidal complex were analyzed with the Pearson correlation and Chi-squared tests according to the type of data compared and logistic regression models ( p < 0.05).
Results We observed that an increase of one unit in the volume of OCs also increases the chance of extension of pneumatization into the clinoid processes by 0.15% ( p = 0.001). No significant correlations were identified regarding age, gender, and volume of the OCs.
Conclusion The volume of the OCs has effects on the extension of pneumatization into the clinoid processes.
... • Presellar type: SS ends anteriorly to the anterior edge of sella • Sellar type: posterior wall of the SS is between the anterior and posterior walls of the sella. • Post-sellar type: posterior wall of the SS is located behind the posterior wall of the sella (Fig. 2) [3]. ...
... Non-pneumatized and conchal types are less favourable for a transsphenoidal approach to sellar and parasellar lesions, as it requires thick bone perforation and long operative times [3]. ...
... Internal carotid artery, optic nerve, Vidian nerve, or maxillary nerves can protrude into the sphenoid sinus. Vidian or maxillary nerve protrusions are associated with neuralgia in sphenoid sinus disease [3]. When the inter-sphenoid septum is deflected to one side, attaching to the bony wall, mainly covering the carotid artery, avulsion of septum during surgery can lead to arterial injury. ...
The sphenoid sinus (SS) is one of the
four paired paranasal sinuses (PNSs) within the sphenoid bone body. Isolated pathologies of sphenoid sinus are uncommon. The patient may have various presentations like headache, nasal discharge, post nasal drip, or non-specific symptoms. Although rare, potential complications of sphenoidal sinusitis can range from mucocele to skull base or cavernous sinus involvement, or cranial neuropathy. Primary tumors are rare and adjoining tumors secondarily invading the sphenoid sinus is seen. Multidetector computed tomography (CT) scan and magnetic resonance imaging (MRI) are the primary imaging modalities used to diagnose various forms of sphenoid sinus lesions and complications. We have compiled anatomic variants and various pathologies affecting sphenoid sinus lesions in this article.
... (10) ICA protrusion into the sphenoid sinus shows wide variation among diverse populations showing a wide range of 3.9 and 41.0%. (16) Our sample shows a lower frequency which is 10.3% of ICA protrusion into the sphenoid sinus. This is similar to that reported in Turkish population by Halil Arsalan et al who reported a frequency of 8%. ...
Objective: To find out the frequency of protrusion of Internal Carotid artery in sphenoid sinus and dehiscence of carotid canal in a subset of Karachi population. Study design: This was a Cross-sectional study conducted at Radiology department of Ziauddin university. Methodology: We analyzed 270 head and neck CT scans 270 Head and neck CT scans (540 sides) were analyzed. CT was performed on a 16 slice Toshiba Alexion at Ziauddin Hospital, Karachi —removed for blind review---. SPSS version 20 was used for data analysis. Results: Out of 270 CT scans analyzed, 28 (10.3) scans showed protrusion of ICA in sphenoid sinus. Out of 45 (16.6) of the subjects showed dehiscence of carotid canal. Out of total dehiscence present unilateral cases were more frequent as compared to bilateral. Unilateral protrusion was also more common as compared to bilateral protrusion of ICA. Conclusion: Knowledge of dehiscence and protrusion related to ICA and sphenoid sinus anatomy is essential to avoid complications in endoscopic sinus surgery.
... This topic may represent an important issue in surgical approaches; in fact, the variants in volume and pneumatisation may allow an easier approach to some structures thanks to a greater working space, and, in contrast, may expose to greater risk of neurovascular damage. 6,24 However, how volume of SS may influence the size of ST has still to be verified in depth. ...
... 26 For what concerns the relationships between measurements and pneumatization variants, a greater volume of SS was found in patients affected by each pneumatized structure (pterygoid processes, clinoid processes, dorsum sellae, greater wings), as already verified in the literature. 5,24 In addition, the present results demonstrate some relationships between the pneumatisation variants and the sellar measurements: in males, pneumatisation of greater wings of the sphenoid bone is linked with lower AP diameter and depth of ST, whereas in females pneumatization of pterygoid processes is shown by patients with lower sellar depth. These results prove that pneumatization variants may influence the size of ST, especially in wider SS, which is usually found in case of pneumatization of the greater wings. ...
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.
... Inside the sphenoid sinus there are several normal anatomic variations that can make a surgery simpler or more challenging [1][2][3][4][5][6]. Not taking them into account may lead to serious complications [7,8]. This sinus is present at birth as a minuscule cavity and most of its development occurs after puberty. ...
We present a detailed description of the radiological anatomy of the sphenoid sinus and neurovascular structures that surround it from an endoscopic endonasal skull base surgical perspective and in an exclusively Mexican patient population. We performed a cross-sectional study of 500 patients form the Neurosurgery Patient Database at the Specialties Hospital of the 21st Century National Medical Center. Inclusion criteria were minimum age of 18 years old, availability of fine cut CT with skull base reconstruction, absence of skull base pathology, trauma, and radiological artifacts or distortion at the area of study.
... The inconsistent position of the sphenoid septum, along with the degree and direction disparities of sinus pneumatization, has indeed accorded the sphenoid sinus a unique structure in providing invaluable information in forensic personnel identification. The degree of pneumatization of the sphenoid sinus ranges from absence or poor (conchal type) to hyperextension beyond the basal surface of the sphenoid bone, with potential involvement of the anterior and posterior clinoid processes, the lesser and greater sphenoid wings, the pterygoid process and plates, and into the clivus [9]. Additionally, the deep anatomical location of the sphenoid sinus within the sphenoid body is well protected from traumatic degradation resulting from an external cause [6,10]. ...
Introduction: The fundament of forensic science lies in identifying a body. The morphological complexity of the paranasal sinus (PNS), which varies greatly amongst individual, possess a discriminatory value that potentially contributes to the radiological identification. The sphenoid bone represents the keystone of the skull and forms part of the cranial vault. It is intimately associated with vital neurovascular structures. The sphenoid sinus, located within the body of the sphenoid bone, has variable morphology. The sphenoid septum's inconsistent position and the degree, as well as the direction disparities of sinus pneumatization, have indeed accorded it a unique structure in providing invaluable information in forensic personnel identification. Additionally, the sphenoid sinus is situated deep within the sphenoid bone. Therefore, it is well protected from traumatic degradation from external causes and can be potentially utilized in forensic studies. The authors aim to study the possibility of variation among the race, and gender in the Southeast Asian (SEA) population, using volumetric measurements of the sphenoid sinus.
Materials and methods: This is a retrospective cross-sectional analysis of computerized tomographic (CT) imaging of the PNS of 304 patients (167 males, 137 females) in a single centre. The volume of the sphenoid sinus was reconstructed and measured using commercial real-time segmentation software.
Result: The total volume of sphenoid sinus of male gender had shown to be larger, 12.22 (4.93 - 21.09) cm3 compared to the counterpart of 10.19 (3.75 - 18.72) cm3 (p = .0090). The Chinese possessed a larger total sphenoid sinus volume, 12.96 (4.62 - 22.21) cm3) than the Malays, 10.68 (4.13 - 19.25) cm3 (p = .0057). No correlation was identified between the age and volume of the sinus (cc= -.026, p = .6559).
Conclusion: The sphenoid sinus volume in males was found to be larger than those of females. It was also shown that race influences sinus volume. Volumetric analysis of the sphenoid sinus can potentially be utilized in gender and race determination. The current study provided normative data on the sphenoid sinus volume in the SEA region, which can be helpful for future studies.
... Inside the sphenoid sinus there are several normal anatomic variations that can make a surgery simpler or more challenging [1][2][3][4][5][6]. Not taking them into account may lead to serious complications [7,8]. This sinus is present at birth as a minuscule cavity and most of its development occurs after puberty. ...
