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Nizzola M, Leonel LCPC, Peris-Celda M. Neurosurgery for the rhinologist. Curr Opin Otolaryngol Head Neck Surg 2024; 32:40-49. [PMID: 38193519 DOI: 10.1097/moo.0000000000000950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide a comprehensive anatomical appraisal of the neurosurgical anatomy exposed through the endonasal and paranasal sinuses routes, focusing on the most common expanded endonasal approaches (EEAs) as well as recent advances in this surgical field. RECENT FINDINGS The EEAs are redefining the management of skull base pathology. Neurovascular structures previously considered a limitation, can be now approached through these surgical corridors. Advances in this field include the development of new surgical techniques and routes that allow better visualization and access to pathologies located in the ventral skull base. Understanding the surgical anatomy related to EEAs is essential not only for neurosurgeons but also for rhinologists. SUMMARY Knowledge of the surgical anatomy of the most common EEAs that utilize paranasal sinuses as a surgical corridor enables more effective management of complex skull base pathologies. Comprehensive anatomical knowledge of these corridors and the surrounding neurovascular structures is crucial to maximize benefits of EEAs and improve outcomes.
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Affiliation(s)
- Mariagrazia Nizzola
- Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurosurgery and Gamma Knife radiosurgery, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Luciano C P C Leonel
- Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Maria Peris-Celda
- Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Shamlou AA, Tallman SD. Frontal Sinus Morphological and Dimensional Variation as Seen on Computed Tomography Scans. BIOLOGY 2022; 11:biology11081145. [PMID: 36009772 PMCID: PMC9405290 DOI: 10.3390/biology11081145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/22/2022] [Accepted: 07/27/2022] [Indexed: 11/16/2022]
Abstract
Frontal sinus variation has been used in forensic anthropology to aid in positive identification since the 1920s. As imaging technology has evolved, so has the quality and quantity of data that practitioners can collect. This study examined frontal sinus morphological and dimensional variation on computed tomography (CT) scans in 325 individuals for assigned sex females and males from African-, Asian-, European-, and Latin American-derived groups. Full coronal sinus outlines from medically derived CT images were transferred into SHAPE v1.3 for elliptical Fourier analysis (EFA). The dimensional data were measured directly from the images using the MicroDicom viewer. Statistical analyses—Pearson’s chi-square, ANOVA, and Tukey post hoc tests—were run in R Studio. Results indicated that 3.7% lacked a frontal sinus and 12.0% had a unilateral sinus, usually on the left (74.3%). Additionally, no statistically significant morphological clustering using EFA was found based on assigned sex and/or population affinity. However, there were statistically significant differences dimensionally (height and depth) when tested against assigned sex and population affinity, indicating that the interactive effects of sexual dimorphism and adaptive population histories influence the dimensions but not the shape of the frontal sinus.
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Affiliation(s)
- Austin A. Shamlou
- Department of Anatomy & Neurobiology, Boston University School of Medicine, 72 E. Concord St. L1004, Boston, MA 02118, USA;
| | - Sean D. Tallman
- Department of Anatomy & Neurobiology, Boston University School of Medicine, 72 E. Concord St. L1004, Boston, MA 02118, USA;
- Department of Anthropology, Boston University, Boston, MA 02215, USA
- Correspondence: ; Tel.: +1-617-358-1810
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Hendricks BK, Cohen-Gadol AA. The Extended Pterional Craniotomy: A Contemporary and Balanced Approach. Oper Neurosurg (Hagerstown) 2021; 18:225-231. [PMID: 31172173 DOI: 10.1093/ons/opz117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 02/17/2019] [Indexed: 11/14/2022] Open
Abstract
Pterional craniotomy is the workhorse approach among cranial operative corridors. It is a highly flexible skull base approach that affords excellent exposure of the anterior cranial fossa, the circle of Willis, and the interpeduncular region. Its strategic use via dynamic retraction can obviate the need to use a more extensive skull base route, such as orbitozygomatic osteotomy, in select cases. The focus of the surgeon should be reaching the surgical target effectively while minimizing disruption of normal anatomy. In other words, the focus should be less on "how to get there" and more on "what to do when you are there." This multimedia presentation summarizes an efficient execution of this route and its expansion and demonstrates the surgical corridor via 3-dimensional virtual reality models.
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Affiliation(s)
| | - Aaron A Cohen-Gadol
- Neurosurgical Atlas, Indianapolis, Indiana.,Goodman Campbell Brain and Spine, Indiana University Department of Neurosurgery, Indianapolis, Indiana
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Ostergard TA, Glenn CA, Dekker SE, Bambakidis NC. Is the Supraorbital Notch a Reliable Landmark to Avoid the Frontal Sinus? Oper Neurosurg (Hagerstown) 2020; 16:360-367. [PMID: 30169851 DOI: 10.1093/ons/opy223] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 07/18/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND When performing a craniotomy involving the orbital bar, the supraorbital notch is a potential landmark to localize the lateral extent of the frontal sinus. Avoidance of the frontal sinus is important to reduce the risk of postoperative surgical site infection, epidural abscess formation, and mucocele development. OBJECTIVE To determine the reliability of the supraorbital notch as a marker of the lateral location of the frontal sinus. METHODS Cadaveric dissections were used with image guidance software to define the relationship between the frontal sinus and supraorbital foramen. RESULTS The supraorbital notch was located 2.54 cm from midline and the lateral extent of the frontal sinus extended 2.84 mm lateral to the supraorbital notch. When performing a craniotomy extending medially to the supraorbital notch at a perpendicular angle, the frontal sinus was breached in 65% of craniotomies. When the craniotomy ended 10 mm lateral to the supraorbital notch, the rate of frontal sinus breach decreased to 10%. CONCLUSION When performing a craniotomy involving the supraorbital notch, a lateral to medial trajectory that ends 15 mm to the supraorbital notch will minimize the risk of frontal sinus violation.
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Affiliation(s)
- Thomas A Ostergard
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Chad A Glenn
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Simone E Dekker
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Nicholas C Bambakidis
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
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Olesen ND, Jørgensen TB, Eiberg J, Helgstrand UJV, Sillesen HH, Cedergreen P, Secher NH, Nielsen HB. Elevated Renal Oxygen Extraction During Open Abdominal Aortic Aneurysm Repair Is Related to Postoperative Renal Dysfunction. Semin Cardiothorac Vasc Anesth 2018; 22:369-375. [PMID: 30047299 DOI: 10.1177/1089253218790270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Open abdominal aortic aneurysm repair is often followed by elevated plasma creatinine, likely due to impaired renal blood flow. We evaluated whether postoperative elevation in creatinine relates to renal oxygen extraction during surgery as an index of renal blood flow and also monitored frontal lobe oxygenation. METHODS For 19 patients (66 ± 10 years; mean ± SD) undergoing open infrarenal abdominal aortic aneurysm repair, renal oxygen extraction was determined by arterial and renal vein catheterization. Near-infrared spectroscopy determined frontal lobe oxygenation. RESULTS During surgery mean arterial pressure (from 102 ± 14 to 65 ± 11 mm Hg; P < .0001), arterial hemoglobin (from 7.7 ± 0.7 to 6.6 ± 0.8 mmol/L; P < 0.0001), and frontal lobe oxygenation (from 74 ± 6% to 70 ± 6%; P = .0414) decreased, while renal oxygen extraction increased (from 5.3% [4.3-8.1]; median [interquartile range] to 10.8% [5.8-17.5]; P = .0405). Plasma creatinine became significantly elevated on the second day after the operation (from 83 [73-101] to 105 µmol/L [79-143]; P = .0062) with a peak increase observed after 2 days (1-2). The peak increase in creatinine correlated to intraoperative renal oxygen extraction ( r = 0.51; P = .026). CONCLUSION Kidney function was affected after open abdominal aortic aneurysm repair likely related to limited renal blood flow. We take the increase in renal oxygen extraction and reduction in frontal lobe oxygenation to suggest that mean arterial pressure and hemoglobin were too low to maintain renal and cerebral circulation in vascular surgical patients.
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Nikolova S, Toneva D, Georgiev I, Dandov A, Lazarov N. Morphometric analysis of the frontal sinus: application of industrial digital radiography and virtual endocast. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.jofri.2018.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Nikolova S, Toneva D, Georgiev I, Lazarov N. Digital radiomorphometric analysis of the frontal sinus and assessment of the relation between persistent metopic suture and frontal sinus development. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2017; 165:492-506. [PMID: 29266191 DOI: 10.1002/ajpa.23375] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 12/03/2017] [Accepted: 12/04/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVES This study aimed to establish the frequency of the frontal sinus (FS) aplasia, to compare metopic and nonmetopic series and thus to assess the relationship between the preservation of metopic suture and FS development. MATERIALS AND METHODS FSs were investigated in 230 dry skulls of adult males distributed into control (137) and metopic (93) series. They were visualized through industrial digital radiography. RESULTS In the control series, the FS aplasia was observed in 12.41% of the skulls, and it was mostly unilateral (8.76%) than bilateral (3.65%). The left-sided aplasia (5.11%) slightly prevailed over the right-sided one (3.65%). In the metopic series, the aplasia was observed with a frequency of 19.35%, and the bilateral aplasia (7.53%) was rarer that the unilateral one (11.83%), while the right-sided aplasia was clearly predominant (9.68%) compared to the left-sided one (2.15%). DISCUSSION The significant differences between both series showed a tendency for the persistence of metopic suture to be frequently related with FS underdevelopment in the vertical plate of the frontal bone, but in cases of pneumatization, it was preferentially on the left side. Taking into account that the cranial hypertension leads to suture diastasis and hinders development of the FS, it could be suggested that persistence of the metopic suture along with underdevelopment of the FS in nonsyndromic adults could be an expression of an elevated intracranial pressure during early development as an after-effect of certain condition.
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Affiliation(s)
- Silviya Nikolova
- Department of Anthropology and Anatomy, Institute of Experimental Morphology, Pathology and Anthropology with Museum, Bulgarian Academy of Sciences, Sofia 1113, Bulgaria
| | - Diana Toneva
- Department of Anthropology and Anatomy, Institute of Experimental Morphology, Pathology and Anthropology with Museum, Bulgarian Academy of Sciences, Sofia 1113, Bulgaria
| | - Ivan Georgiev
- Department of Scientific Computations, Institute of Information and Communication Technologies, Bulgarian Academy of Sciences, Sofia 1113, Bulgaria.,Department of Mathematical Modeling and Numerical Analysis, Institute of Mathematics and Informatics, Bulgarian Academy of Sciences, Sofia 1113, Bulgaria
| | - Nikolai Lazarov
- Department of Anatomy and Histology, Medical University of Sofia, Sofia 1431, Bulgaria.,Department of Synaptic Signaling and Communications, Institute of Neurobiology, Bulgarian Academy of Sciences, Sofia 1113, Bulgaria
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Štoković N, Trkulja V, Čuković-Bagić I, Lauc T, Grgurević L. Anatomical variations of the frontal sinus and its relationship with the orbital cavity. Clin Anat 2017; 31:576-582. [PMID: 29044800 DOI: 10.1002/ca.22999] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/06/2017] [Accepted: 10/13/2017] [Indexed: 11/10/2022]
Abstract
The anatomy of the frontal sinus is highly variable and its variations affect the occurrence/course of pathological processes. We investigated its size and relationship to the orbit, searching for patterns that would allow it to be classified anatomically. Cone beam computed tomography was applied to 91 skulls (age range 21-86 years) to determine sinus height, width, length, and length of contact with the orbit in the coronal and sagittal planes. In addition, orbital roof pneumatization in the coronal plane was categorized as: none; only medial part pneumatized; the medial and a portion of the central part pneumatized; roof predominantly pneumatized. Sinus dimensions varied widely (mm): height 6.2-50.0; width 3.7-54.0; length 2.4-45.0; frontal orbital contact 4.0-41.6; sagittal orbital contact 0.0-41.2. Pneumatization of the orbital roof (coronal plane) mostly affected the medial and a portion of the central part (50%), or the roof was predominantly pneumatized (32%). Three "types" of sinus (cluster analysis) were distinguished by the extent of pneumatization of the orbital roof in the coronal plane: "small", pneumatization absent or only of the medial part; "medium-sized", pneumatization of the medial and a portion of the central part; "large", roof predominantly pneumatized. All dimensions were significantly different among the types (P < 0.001). Sinus type was fairly predictive of the extent of contact with the orbit in the sagittal plane (not routinely assessed clinically). The data confirm the variability of frontal sinus anatomy and suggest a simple and straightforward classification with potential clinical relevance. Clin. Anat. 31:576-582, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Nikola Štoković
- Laboratory for Mineralized Tissues, Center for Translational and Clinical Research, School of Medicine, University of Zagreb, Zagreb, 10000, Croatia
| | - Vladimir Trkulja
- Department of Pharmacology, School of Medicine, University of Zagreb, Croatia, Zagreb, 10000, Croatia
| | - Ivana Čuković-Bagić
- Department of Paediatric and Preventive Dentistry, School of Dental Medicine, University of Zagreb, Croatia, Zagreb, 10000, Croatia.,Department of Dental Medicine, University Hospital Center Zagreb, Croatia, Zagreb, 10000, Croatia
| | - Tomislav Lauc
- Department of Anthropology, Faculty of Social Sciences and Humanities, University of Zagreb, Zagreb, 10000, Croatia.,Department of Otorhinolaryngology and Maxillofacial Surgery, Faculty of Medicine, University of Osijek, Osijek, 31000, Croatia
| | - Lovorka Grgurević
- Laboratory for Mineralized Tissues, Center for Translational and Clinical Research, School of Medicine, University of Zagreb, Zagreb, 10000, Croatia
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9
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Alekseev AG, Pichugin AA, Danilov VI. [A supraorbital trans-eyebrow approach in surgery of chiasmatic-sellar and anterior cranial fossa tumors]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2017; 81:36-45. [PMID: 29076466 DOI: 10.17116/neiro201781536-45] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE to analyze 31 resections of chiasmatic-sellar region (CSR) and anterior cranial fossa (ACF) tumors using the supraorbital trans-eyebrow approach (STA). MATERIAL AND METHODS We analyzed medical histories of 31 patients who underwent tumor resection using STA in the period between October 2013 and April 2017. We analyzed the age and gender of patients, size and location of the tumor, presence of a neurological deficit, vision and olfactory functions before and after surgery, surgery duration, amount of intraoperative blood loss, rate of frontal sinus trephination and nasal liquorrhea, hemorrhagic and ischemic complications after surgery, Simpson grade of tumor resection, patient's condition before and after surgery (Glasgow Outcome Scale and Karnofsky Scale), and degree of patient satisfaction with the cosmetic result of surgery. A total of 26 meningiomas (20 sphenoid plate, tubercle, and diaphragm tumors, 3 lesser sphenoid wing meningiomas, 2 orbital roof tumors, and 1 anterior clinoid process meningioma), 3 frontal lobe gliomas, and 2 pituitary adenomas were resected. RESULTS In all 31 operations, the approach was adequate and enabled tumor resection without lethal outcomes. The mean surgery duration was 174.6±64.4 min. The mean blood loss was 190±96.6 mL (50-380 mL). After surgery, none of the patients developed motor deficits and new epileptic seizures. Neurological deficit aggravation in the form of impaired vision and mental disorders occurred in 8 (25.8%) patients. Vision impaired in 4 (12.9%) patients, improved in 6 (19.3%) patients, and remained unchanged in 21 (67.7%) patients. An endocrinological deficit in the form of partial hypopituitarism developed in 3 (9.6%) patients; in 4 (12.9%) patients, there were mental disorders that regressed by the end of the first month of therapy. There were no intracerebral and subarachnoid hemorrhages. In 2 (6.4%) patients, small epidural hematomas were diagnosed, which did not require surgical treatment. There were only good outcomes (a GOS score of 4 or 5). After surgery, the median Karnofsky index in the STA group was 90±7. In all 31 (100%) patients, the postoperative wound healed by primary intention, without infectious complications and wound liquorrhea. One (4%) patient developed eyebrow palsy; 3 (12%) patients had hypoesthesia in the supraorbital region. The mean VAS score of patient satisfaction with the cosmetic result was 9.36 (median 10±1). The mean follow-up period was 16.2±13.5 months (2-38 months). CONCLUSION The STA is adequate for removal of CSR and ACF tumors under proper selection of patients. It provides an adequate view of anatomical structures and enables successful tumor resection through a less traumatic access.
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Affiliation(s)
- A G Alekseev
- Kazan State Medical University, Kazan, Republic of Tatarstan, Russia; Interregional Clinical and Diagnostic Center, Kazan, Republic of Tatarstan, Russia
| | - A A Pichugin
- Kazan State Medical University, Kazan, Republic of Tatarstan, Russia; Interregional Clinical and Diagnostic Center, Kazan, Republic of Tatarstan, Russia
| | - V I Danilov
- Kazan State Medical University, Kazan, Republic of Tatarstan, Russia; Interregional Clinical and Diagnostic Center, Kazan, Republic of Tatarstan, Russia
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Frontal Sinus Pneumatization Affects Height of the Lateral Lamella and Position of Anterior Ethmoidal Artery. J Craniofac Surg 2017; 28:265-269. [PMID: 27930469 DOI: 10.1097/scs.0000000000003263] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Preoperative evaluation of the frontal sinus (FS) and associated anatomical structures may reduce the risk of intraoperative complications and facilitate the management of potential complications. In this study, the authors aimed to evaluate relationship between FS pneumatization and critical anatomical structures. Paranasal sinus computerized tomography scans of 350 sides of 175 patients were evaluated. The pneumatization pattern of the FS, FS dimensions (on the axial, coronal, and sagittal slices), anterior ethmoidal artery, and depth of the of olfactory fossa were evaluated for every patient on both sides. There were 111 (63.4%) male and 64 (36.6%) female patients. The authors found a statistically significant correlation between the depth of olfactory fossa and the anterior ethmoidal artery position (P <0.001). As the FS pneumatization increases, the likelihood of the anterior ethmoid artery to run separately from the skull base also increases. Also, there was a statistically significant difference among the types in terms of the depth of the olfactory fossa (Kruskal-Wallis P = 0.002). The depth of the olfactory fossa increases depending on the increase of FS pneumatization.Our study shows that the olfactory fossa depth (skull-base depth) increases as FS pneumatization increases. In light of this information, the evaluation of the preoperative sinus computerized tomography scans will help in performing safer endoscopic sinus surgeries.
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Flanigan P, Kshettry VR, Mullin JP, Jahangiri A, Recinos PF. Frontal Sinus Morphometry in Relation to Surgically Relevant Landmarks in the United States Population. World Neurosurg 2016; 91:12-5. [PMID: 26979924 DOI: 10.1016/j.wneu.2016.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 03/04/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Knowledge of frontal sinus morphometry is important in bifrontal, pterional, orbitozygomatic, and supraorbital craniotomies. Inadvertent frontal sinus violation can lead to infection, cerebrospinal fluid fistula, and mucocele formation. In particular, knowledge of anatomy in relation to surgically relevant landmarks can help surgeons perform these procedures more precisely and safely. We performed a descriptive radiographic analysis to better understand variations in frontal sinus anatomy. METHODS Using 3-dimensional reconstructive software, we analyzed 162 normal cranial computerized tomographic angiograms (from 80 men and 82 women). A line between the supraorbital notches (SONs) was used as a horizontal reference line (HRL). We recorded the maximum sinus height and width from the HRL and midline, respectively. In addition, sinus width was measured in relation to the SON at 0, 1, and 2 cm above the HRL. RESULTS The mean maximal sinus height from the HRL was 1.8 cm. The mean maximum sinus width was 2.6 cm (right and left) from midline and 0.46 cm (right) and 0.49 cm (left) from the SON. Less than 11% of sinuses were lateral to the SON at 2.0 cm above the HRL and <6% of sinuses were >1.5 cm lateral to the SON at 1.0 cm above the HRL. CONCLUSIONS Planned surgical corridors >1.5 cm lateral to the SON and/or >3.0 cm above the HRL are most likely to avoid the frontal sinus based on our radiographic measurements of normal sinus anatomy. Careful radiographic study and appropriate planning for more medial and/or inferior corridors is suggested.
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Affiliation(s)
- Patrick Flanigan
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Varun R Kshettry
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jeffrey P Mullin
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Arman Jahangiri
- Department of Neurosurgery, California Center for Pituitary Disorders, University of California, San Francisco, California, USA
| | - Pablo F Recinos
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA; Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA; Section of Rhinology, Sinus, and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA.
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12
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Yüksel Aslier NG, Karabay N, Zeybek G, Keskinoğlu P, Kiray A, Sütay S, Ecevit MC. The classification of frontal sinus pneumatization patterns by CT-based volumetry. Surg Radiol Anat 2016; 38:923-30. [PMID: 26884400 DOI: 10.1007/s00276-016-1644-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 02/06/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE We aimed to define the classification of frontal sinus pneumatization patterns according to three-dimensional volume measurements. METHODS Datasets of 148 sides of 74 dry skulls were generated by the computerized tomography-based volumetry to measure frontal sinus volumes. The cutoff points for frontal sinus hypoplasia and hyperplasia were tested by ROC curve analysis and the validity of the diagnostic points was measured. RESULTS The overall frequencies were 4.1, 14.2, 37.2 and 44.5 % for frontal sinus aplasia, hypoplasia, medium size and hyperplasia, respectively. The aplasia was bilateral in all three skulls. Hypoplasia was seen 76 % at the right side and hyperplasia was seen 56 % at the left side. The cutoff points for diagnosing frontal sinus hypoplasia and hyperplasia were '1131.25 mm(3)' (95.2 % sensitivity and 100 % specificity) and '3328.50 mm(3)' (88 % sensitivity and 86 % specificity), respectively. CONCLUSIONS The findings provided in the present study, which define frontal sinus pneumatization patterns by CT-based volumetry, proved that two opposite sides of the frontal sinuses are asymmetric and three-dimensional classification should be developed by CT-based volumetry, because two-dimensional evaluations lack depth measurement.
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Affiliation(s)
- Nesibe Gül Yüksel Aslier
- Department of Otorhinolaryngology, Dokuz Eylul University School of Medicine, Izmir, Turkey.
- Silopi Devlet Hastanesi, Yenişehir Mah. 8. Cadde. No:73, Silopi, Şırnak, Turkey.
| | - Nuri Karabay
- Department of Radiology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Gülşah Zeybek
- Department of Anatomy, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Pembe Keskinoğlu
- Department of Biostatistics, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Amaç Kiray
- Department of Anatomy, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Semih Sütay
- Department of Otorhinolaryngology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Mustafa Cenk Ecevit
- Department of Otorhinolaryngology, Dokuz Eylul University School of Medicine, Izmir, Turkey
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13
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Kitchen CC, Nissen P, Secher NH, Nielsen HB. Preserved frontal lobe oxygenation following calcium chloride for treatment of anesthesia-induced hypotension. Front Physiol 2014; 5:407. [PMID: 25374543 PMCID: PMC4205832 DOI: 10.3389/fphys.2014.00407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 10/01/2014] [Indexed: 01/05/2023] Open
Abstract
Vasopressor agents may affect cerebral oxygenation (rScO2) as determined by near-infrared spectroscopy on the forehead. This case series evaluated the effect of calcium chloride vs. α and β-adrenergic receptor agonists on rScO2 in patients (n = 47) undergoing surgery during i.v. anesthesia. Mean arterial pressure (MAP) and cardiac output (CO) were assessed by Model-flow® and ephedrine (55 ± 3 vs. 74 ± 9 mmHg; 10 mg, n = 9), phenylephrine (51 ± 5 vs. 78 ± 9 mmHg, 0.1 mg, n = 11), adrenaline (53 ± 3 vs. 72 ± 11 mmHg; 1–2 μg, n = 6), noradrenaline (53 ± 5 vs. 72 ± 12 mmHg; 2–4 μg, n = 11), and calcium chloride (49 ± 7 vs. 57 ± 16 mmHg; 5 mmol, n = 10) increased MAP (all P < 0.05). CO increased with ephedrine (4.3 ± 0.9 vs. 5.3 ± 1.2, P < 0.05) and adrenaline (4.7 ± 1.2 vs. 5.9 ± 1.1 l/min; P = 0.07) but was not significantly affected by phenylephrine (3.9 ± 0.7 vs. 3.6 ± 1.0 l/min), noradrenaline (3.8 ± 1.2 vs. 3.7 ± 0.7 l/min), or calcium chloride (4.0 ± 1.4 vs. 4.1 ± 1.5 l/min). Following administration of β-adrenergic agents and calcium chloride rScO2 was preserved while after administration of α-adrenergic drugs rScO2 was reduced by app. 2% (P < 0.05). Following α-adrenergic drugs to treat anesthesia-induced hypotension tissue oxygenation is reduced while the use of β-adrenergic agonists and calcium chloride preserve tissue oxygenation.
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Affiliation(s)
| | - Peter Nissen
- Department of Anesthesia, Rigshospitalet, University of Copenhagen Copenhagen, Denmark
| | - Niels H Secher
- Department of Anesthesia, Rigshospitalet, University of Copenhagen Copenhagen, Denmark
| | - Henning B Nielsen
- Department of Anesthesia, Rigshospitalet, University of Copenhagen Copenhagen, Denmark
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Rokamp KZ, Secher NH, Eiberg J, Lønn L, Nielsen HB. O2 supplementation to secure the near-infrared spectroscopy determined brain and muscle oxygenation in vascular surgical patients: a presentation of 100 cases. Front Physiol 2014; 5:66. [PMID: 24611051 PMCID: PMC3933814 DOI: 10.3389/fphys.2014.00066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 02/03/2014] [Indexed: 12/27/2022] Open
Abstract
This study addresses three questions for securing tissue oxygenation in brain (rScO2) and muscle (SmO2) for 100 patients (age 71 ± 6 years; mean ± SD) undergoing vascular surgery: (i) Does preoxygenation (inhaling 100% oxygen before anesthesia) increase tissue oxygenation, (ii) Does inhalation of 70% oxygen during surgery prevent a critical reduction in rScO2 (<50%), and (iii) is a decrease in rScO2 and/or SmO2 related to reduced blood pressure and/or cardiac output?Intravenous anesthesia was provided to all patients and the intraoperative inspired oxygen fraction was set to 0.70 while tissue oxygenation was determined by INVOS 5100C. Preoxygenation increased rScO2 (from 65 ± 8 to 72 ± 9%; P < 0.05) and SmO2 (from 75 ± 9 to 78 ± 9%; P < 0.05) and during surgery rScO2 and SmO2 were maintained at the baseline level in most patients. Following anesthesia and tracheal intubation an eventual change in rScO2 correlated to cardiac output and cardiac stroke volume (coefficient of contingence = 0.36; P = 0.0003) rather to a change in mean arterial pressure and for five patients rScO2 was reduced to below 50%. We conclude that (i) increased oxygen delivery enhances tissue oxygenation, (ii) oxygen supports tissue oxygenation but does not prevent a critical reduction in cerebral oxygenation sufficiently, and (iii) an eventual decrease in tissue oxygenation seems related to a reduction in cardiac output rather than to hypotension.
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Affiliation(s)
- Kim Z Rokamp
- Departments of Anesthesia, Rigshospitalet, University of Copenhagen Copenhagen, Denmark
| | - Niels H Secher
- Departments of Anesthesia, Rigshospitalet, University of Copenhagen Copenhagen, Denmark
| | - Jonas Eiberg
- Vascular Surgery, Rigshospitalet, University of Copenhagen Copenhagen, Denmark
| | - Lars Lønn
- Interventional Radiology, Rigshospitalet, University of Copenhagen Copenhagen, Denmark
| | - Henning B Nielsen
- Departments of Anesthesia, Rigshospitalet, University of Copenhagen Copenhagen, Denmark
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Tubbs RS, Loukas M, Shoja MM, Cohen-Gadol AA. Refined and simplified surgical landmarks for the MacCarty keyhole and orbitozygomatic craniotomy. Neurosurgery 2010; 66:230-3. [PMID: 20489510 DOI: 10.1227/01.neu.0000369650.69583.9c] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Precise placement of the MacCarty keyhole, a burr hole simultaneously exposing the anterior cranial fossa floor and orbit, provides accurate, efficient entry for orbitozygomatic and supraorbital craniotomies. To locate the optimal keyhole site, previous studies have used superficial landmarks that, in our experience, are not always visible or consistent on older crania. OBJECTIVE Therefore, we present a technique for accurate keyhole placement using landmarks that are easily visible across age ranges. METHODS From inside the cranium, 1-mm burr holes were placed along the anterior junction of the floor and lateral wall of the anterior cranial fossa in 50 adult skulls (100 sides, with calvaria removed). Additionally, from inside the orbit, 1-mm burr holes were placed into the lateral orbital roof. Exit sites of intracranial and intraorbital burr holes were referenced to the frontozygomatic suture. The center of the site between the exiting intracranial and intraorbital holes was deemed the best location for the keyhole. RESULTS The keyhole center was 6.8 mm (mean) superior and 4.5 mm (mean) posterior to the frontozygomatic suture, which was easily identified on all specimens. Although this keyhole center was slightly more superior on right sides than left, this was not statistically significant. In a minority of specimens, the keyhole was located near the meningo-orbital foramen (22%) and the lateral extent of the frontal sinus (2%). CONCLUSIONS We defined an alternative method for locating the MacCarty keyhole, based on a reliable external landmark, approximately 7 mm superior and 5 mm posterior to the frontozygomatic suture.
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Affiliation(s)
- R Shane Tubbs
- Section of Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama, USA
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16
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Cheong ML, Chan CYW, Saw LB, Kwan MK. Pneumocranium secondary to halo vest pin penetration through an enlarged frontal sinus. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2009; 18 Suppl 2:269-71. [PMID: 19390875 DOI: 10.1007/s00586-009-1004-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2008] [Revised: 02/03/2009] [Accepted: 04/08/2009] [Indexed: 11/30/2022]
Abstract
We present a case report of a patient with pneumocranium secondary to halo vest pin penetration and a review of literature. The objectives of this study are to report a rare complication of halo vest pin insertion and to discuss methods of prevention of this complication. Halo vest orthosis is a commonly used and well-tolerated upper cervical spinal stabilizing device. Reports of complications related to pin penetration is rare and from our review, there has been no reports of pneumocranium occurring from insertion of pins following standard anatomical landmarks. A 57-year-old male sustained a type 1 traumatic spondylolisthesis of C2/C3 following a motor vehicle accident. During application of the halo vest, penetration of the left anterior pin through the abnormally enlarged frontal sinus occurred. The patient developed headache, vomiting and CSF rhinorrhoea over his left nostril. He was treated with intravenous Ceftriaxone for 1 week. This resulted in resolution of his symptoms as well as the pneumocranium. In conclusion, complications of halo vest pin penetration are rare and need immediate recognition. Despite the use of anatomical landmarks, pin penetration is still possible due to aberrant anatomy. All patients should have a skull X-ray with a radio-opaque marker done prior to placement of the halo vest pins and halo vest pins have to be inserted by experienced personnel to enable early detection of pin penetration.
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Affiliation(s)
- Min Lee Cheong
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia.
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Tatlisumak E, Ovali GY, Asirdizer M, Aslan A, Ozyurt B, Bayindir P, Tarhan S. CT study on morphometry of frontal sinus. Clin Anat 2008; 21:287-93. [PMID: 18428994 DOI: 10.1002/ca.20617] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The aim of this study was to determine the prevalence and morphological characteristics of the frontal sinus in an adult population. This study was conducted retrospectively on paranasal CT scans in the axial and coronal planes of 300 cases (123 male and 177 female). The mean age was 40.74 +/- 13.34 (range 20-83). Measurements of the width, height and anteroposterior length for each sinus and total width were obtained from CT scans. Measurements were compared statistically with relation to side and sex. The cases were divided into subgroups according to age for each sex and each measurement parameter was also compared among the subgroups. All measurements tended to be larger on the left side and were significantly larger in males than females. There was a significant difference in the anteroposterior lengths of right and left sides in both males and females and height for males and width for females. In both sexes, the highest values of measurements were usually observed at the 31-40 age group and there was a tendency to decrease with aging. The larger diameters of the left frontal sinus imply that it may be more possibly violated during surgical interventions. Morphometric features differed significantly in the two sexes at different ages and comparison with previous studies presented great regional variability. The size of the frontal sinus was seen to be related to age and sex. The knowledge provided in the present study is useful for some surgical procedures and widens the anthropometric knowledge of humanity.
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Affiliation(s)
- Ertugrul Tatlisumak
- Department of Anatomy, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
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18
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Gharabaghi A, Krischek B, Feigl GC, Rosahl SK, Lüdemann W, Mirzayan MJ, Koerbel A, Samii M, Tatagiba M, Heckl S. Image-guided craniotomy for frontal sinus preservation during meningioma surgery. Eur J Surg Oncol 2007; 34:928-931. [PMID: 18042499 DOI: 10.1016/j.ejso.2007.10.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2007] [Accepted: 10/12/2007] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Preservation of the frontal sinus (FS) during the frontolateral approach to the skull base reduces morbidity, enhances patient comfort, and speeds up the surgical procedure. Due to its irregular outline, mental reconstruction of the borders of FS from two-dimensional images is challenging during surgery. This study was designed to evaluate the impact of neuronavigation on identification and preservation of the FS during frontolateral craniotomies. METHODS Forty-five patients with pathologies located in the anterior skull base and in the parasellar region were included. A standard computed tomography (CT) sequence was obtained from each patient and uploaded onto an image-guidance system for volumetric rendering of 3D images. The outline of the FS was visualized and the distance between its lateral border and the mid-pupillary line (MPL) was measured. The results were used for navigated craniotomies and compared to the intra-operative findings. RESULTS The FS was located medial, on and lateral to the MPL in 32, 4 and 9 cases, respectively. The individual outline of the FS could be identified with a mean target registration error of 1.4mm (+/-0.7 mm). The craniotomy could be custom-tailored for each patient according to the individualized landmarks while visualizing the lesion and the surgical landmarks simultaneously. Unintended opening of the frontal sinus or orbit did not occur in any of these cases. CONCLUSION Image-guided craniotomies based on 3D volumetric image rendering allow for fast and reliable demarcation of complex anatomical structures hidden from direct view in frontolateral approaches. The outline of the frontal sinus and the orbit can be appraised at a glance providing additional safety and precision during craniotomy.
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Affiliation(s)
- A Gharabaghi
- Eberhard Karls University, Tübingen, Germany; International Neuroscience Institute, Hannover, Germany.
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