Pneumatization patterns of human sphenoid sinus associated with the internal carotid artery and optic nerve by CT scan

Introduction: Sphenoid sinus is the most variable structure in human. The prevalence of anatomical variations varies with the population. Increasing endoscopic procedures around the sphenoid sinus and advances in imaging techniques, allowed precise evaluation of sinus anatomical variation in each population. This study measured the prevalences and described the variations of the sphenoid sinus using thin slice contrasted computed tomography scan of brain scans. Materials and Methods: A retrospective cross-sectional study of 250 brain scans of patients between 18-60 years old attending Hospital Tengku Ampuan Afzan, Kuantan, Pahang from 1st January to 31st December 2017. The sphenoid sinus pneumatization types, volume, optic nerve relation according to Delano’s classification, internal carotid artery relation, and the number of sinus septum and attachment site were studied. Results: Post sellar pneumatization type was most common (52%). The mean sinus volume was 19 cm³ which was significantly different between genders. Delano optic nerve type 1 was most frequent (43%) and most were seen bilaterally with significant differences between gender. The internal carotid artery was seen non-protruded 41.6% cases, protruded in 36.4% cases, and protrusion with wall dehiscence in 22% cases. Two septate sinuses were more prominent (44.3%), aseptate sinus in 2.4% cases. The principle septa attachment site was sella (28%), internal carotid artery related septa found in 10% cases and 3.2% of cases with optic nerve septal attachment. Conclusion: This study revealed the presence of all sphenoid sinus variations amongst the study population. The preoperative determination of these anatomical variations minimizes vital neurovascular structures injury.

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Relationship between sphenoid sinus volume and protrusion of internal carotid artery and optic nerve: a 3D segmentation study on maxillofacial CT-scans

Surgical and Radiologic Anatomy ◽

10.1007/s00276-019-02207-w ◽

2019 ◽

Vol 41 (5) ◽

pp. 507-512 ◽

Cited By ~ 6

Author(s):

Daniele Gibelli ◽

Michaela Cellina ◽

Stefano Gibelli ◽

Annalisa Cappella ◽

Antonio Giancarlo Oliva ◽

...

Keyword(s):

Optic Nerve ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Sphenoid Sinus ◽

Internal Carotid ◽

Ct Scans ◽

3D Segmentation

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The Optic Nerve and the Internal Carotid Artery in the Sphenoid Sinus

Ear Nose & Throat Journal ◽

10.1177/014556130208100903 ◽

2002 ◽

Vol 81 (9) ◽

pp. 611-612 ◽

Cited By ~ 1

Author(s):

Eiji Yanagisawa

Keyword(s):

Optic Nerve ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Sphenoid Sinus ◽

Internal Carotid

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Anatomical variations of the sphenoid sinus - a study of 200 cases -

ARS Medica Tomitana ◽

10.2478/arsm-2014-0011 ◽

2014 ◽

Vol 20 (2) ◽

pp. 57-62 ◽

Cited By ~ 4

Author(s):

M. Lupascu ◽

Gh. I. Comsa ◽

V. Zainea

Keyword(s):

Optic Nerve ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Sphenoid Sinus ◽

Internal Carotid ◽

Anatomical Variation ◽

Anatomical Variations ◽

Vidian Canal ◽

Foramen Rotundum ◽

Sphenoid Sinuses

Abstract Our study on the anatomical variation of pneumatisation of the sphenoid sinuses was performed on 200 tomographical studies, evaluating the anatomical variations of the sphenoid sinuses and the Onodi cells, the types of pneumatisation according with the types described by Hammer and Radberg, as well as the extensions of pneumatisation towards the anterior clinoid processes, pterygoid processes and sphenoidal wings; the frequency of intrasphenoidal protrusions and dehiscences of internal carotid artery, optic nerve, Vidian canal and foramen rotundum and the presence of primary and secondary septa attached to their canals.

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Surgical Anatomy and Variations of the Onodi Cell

American Journal of Rhinology ◽

10.2500/105065896781794851 ◽

1996 ◽

Vol 10 (6) ◽

pp. 365-372 ◽

Cited By ~ 27

Author(s):

Debra G. Weinberger ◽

Vijay K. Anand ◽

Mouwafak Al-Rawi ◽

Han J. Cheng ◽

Albert V. Messina

Keyword(s):

Optic Nerve ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Endoscopic Sinus Surgery ◽

Sphenoid Sinus ◽

Internal Carotid ◽

Surgical Anatomy ◽

Sinus Surgery ◽

Ct Scans ◽

Onodi Cell

Onodi cells are posterior ethmoid cells superolateral to the sphenoid sinus that is intimately associated with the optic nerve. Embryologically, they are derived from ethmoid cells that have undergone dedifferentiation. The anatomic relationship of the Onodi cell to the optic nerve and the internal carotid artery has not been clearly documented in the literature. Forty-four sagittal sections of cadaver heads and 83 CT scans of the sinuses were examined. Case studies of three patients with Onodi cell sinusitis are presented. Two patients underwent endoscopic sinus surgery, and the other chose conservative medical management. The cadaver specimens revealed Onodi cells in 14% (6/44 sections). They were located lateral, superior, or superolateral to the sphenoid sinus. These relationships were further delineated by studying CT scans of the sinuses of 76 patients. Six patients (8%) had Onodi cells. Four of them had a dehiscence of the optic nerve adjacent to the Onodi cell. Twelve patients (16%) demonstrated a dehiscence of the internal carotid artery. These findings have important implications in endoscopic sinus surgery. The anatomic variability of the posterior ethmoids, sphenoid sinus, internal carotid artery, and optic nerve makes this surgical approach particularly challenging.

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The central Onodi Cell: A Previously Unreported Anatomic Variation

Allergy & Rhinology ◽

10.2500/ar.2013.4.0047 ◽

2013 ◽

Vol 4 (1) ◽

pp. ar.2013.4.0047 ◽

Cited By ~ 10

Author(s):

Deepa V. Cherla ◽

Senja Tomovic ◽

James K. Liu ◽

Jean Anderson Eloy

Keyword(s):

Optic Nerve ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Sphenoid Sinus ◽

Internal Carotid ◽

Anatomic Variation ◽

Optic Canal ◽

Endoscopic Imaging ◽

Onodi Cell ◽

Unique Variation

Preoperative recognition of the Onodi cell is necessary to avoid injury to closely associated structures, including the internal carotid artery and the optic nerve. This article describes the central Onodi cell, a variation in which a posterior ethmoid cell lies superior to the sphenoid sinus in a midline position with at least one optic canal bulge. To our knowledge, this anatomic variation has not been previously reported in the literature. Radiographic and endoscopic imaging of this unique variation is provided.

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Anatomical variations of sphenoid sinus among patients undergoing computed tomography of paranasal sinus

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20192630 ◽

2019 ◽

Vol 5 (4) ◽

pp. 888 ◽

Cited By ~ 2

Author(s):

Bhanu Pratap Singh ◽

Rajendra Basayya Metgudmath ◽

Divya Singh ◽

Udit Saxena

Keyword(s):

Computed Tomography ◽

Optic Nerve ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Paranasal Sinus ◽

Sphenoid Sinus ◽

Internal Carotid ◽

Three Dimensional ◽

Maxillary Nerve ◽

Vidian Nerve

Background: The approach to sphenoid sinus still remains a clinical challenge, despite the arrival of endoscopy, computed tomography (CT) and functional endoscopic sinus surgery (FESS). The complex and variable anatomy of the sphenoid sinus can be difficult to appreciate with standard axial or coronal CT images of the sinus. The study was done with the objective to study the anatomy of the sphenoid sinus and its variations, and to compare the prevalence of variants obtained in our study with the reported cases in the literature.Methods: The CT scans of 168 normal slides obtained from 84 patients with paranasal sinus were analysed using triplanar imaging provided by 64-slice spiral CT. The prevalence of each of the sphenoid sinus variation was also analysed. Results: Results showed that the prevalence of pneumatization of the anterior clinoid process, greater wing of the sphenoid, and the pterygoid process was 17.85%, 22.61% and 32.14%, respectively. Protrusion of the internal carotid artery, optic nerve, maxillary nerve, and the vidian nerve was 47.61%, 36.90%, 25% and 26.19%, respectively. Dehiscence of internal carotid artery, optic nerve, maxillary nerve, and the vidian nerve was 30.95%, 29.76%, 14.28% and 22.61%, respectively. The prevalence of pneumatization in the Onodi cells was seen in 17.85% of the cases. Association of septa with an internal carotid artery was seen in 29.7% of the cases. Septa attachment to the optic nerve was also observed in 27.3% of the cases.Conclusions: The triplanar imaging (section thickness of 1 mm) is a better three-dimensional image of the sphenoid sinus, compared to coronal imaging. Triplanar imaging guides the surgical approach of the sphenoid sinus with mentally reconstructed three-dimensional images.

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Epistaksis masif pada pseudoaneurisma traumatik arteri karotis interna

Oto Rhino Laryngologica Indonesiana ◽

10.32637/orli.v46i2.166 ◽

2016 ◽

Vol 46 (2) ◽

pp. 184

Author(s):

Anna Mailasari Kusuma Dewi

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Ct Scan ◽

Effective Treatment ◽

Sphenoid Sinus ◽

Internal Carotid ◽

Case Reports ◽

Blood Clot ◽

Artery Pseudoaneurysm ◽

Traumatic Pseudoaneurysm

Latar belakang: Pseudoaneurisma arteri karotis interna merupakan kasus yang jarang dijumpai, dengan gejala berupa perdarahan masif yang dapat terjadi secara lambat dan berulang. Pemeriksaan arteriografi merupakan prosedur standar untuk mengetahui sumber perdarahan. Tindakan embolisasi efektif untuk menghentikan perdarahan. Tujuan: Melaporkan kasus epistaksis masif pada pseudoaneurisma traumatik arteri karotis interna. Kasus: Pasien laki-laki berumur 19 tahun dengan trauma sinus sfenoid pasca kecelakaan, mengalami epistaksis masif berulang selama 7 bulan. Hasil nasoendoskopi didapati bekuan darah pada meatus superior, hasil CT scan menunjukkan lesi isodens pada sinus frontalis dan etmoid kanan, serta sinus sfenoid dan maksila bilateral, disertai gambaran arteri karotis komunis interna segmen kavernosus masuk ke sinus sfenoid melalui celah fraktur di sfenoid. Penatalaksaan berupa embolisasi dengan balloon. Pasca embolisasi tidak didapatkan perdarahan aktif. Metode: Penelusuran kepustakaan menghasilkan 33 jurnal, dan terdapat 10 jurnal yang relevan. Hasil: Dari 10 jurnal yang didapatkan, ditemukan 6 laporan kasus dan 4 hasil penelitian pseudoaneurisma traumatik arteri karotis interna yang ditatalaksana dengan embolisasi, mendapat keberhasilan yang tinggi, dan angka komplikasi yang rendah. Kesimpulan: Pseudoaneurisma traumatik karotis interna menimbulkan epistaksis masif berulang, yang membutuhkan ketepatan pemeriksaan penunjang untuk menegakkan diagnosis. Penatalaksanaan dengan embolisasi merupakan pilihan yang efektif untuk mencegah mortalitas.Kata kunci: Pseudoaneurisma karotis interna, trauma sinus sfenoid, epistaksis masifABSTRACT Background: Post injury internal carotid artery pseudoaneurysm is a rare case, mostly caused by head trauma. The symptoms are delayed and recurrent massive epistaxis. Angiography is the gold standard for confirming the diagnosis and visualizing the bleeding point. Endovascular interventions with depleted balloons and coils are effective treatment. Purpose: To report a case of massive epistaxis related to traumatic pseudoaneurysm of internal carotid artery. Case: A nineteen-years old male with sphenoid sinus injury caused by vehicle accident, which subsequently developed recurrent episodes of massive epistaxis for seventh month afterwards. He had undergone blood transfusion and nasal packing to control the bleeding. Nasal endoscopic examination showed blood clot in the superior meatus, while paranasal sinuses CT Scan showed isodense lesion in the right frontal and ethmoid sinuses, and bilateral sphenoid and maxillary sinuses. Cavernous segment of carotid communis artery entered into sphenoid sinus through a fracture line in the superior part of the sinus. Post arteriography and balloon embolization, there was no active anterior and posterior bleeding. Method: Searching for evidence produced 31 journals, and 10 journals were relevant to our clinical question. Result: From the 10 journals, 6 were case reports and 4 were researches of traumatic pseudoaneurysm of internal carotid artery which were treated by embolization. The results were good and complications were minimal. Conclusion: Traumatic pseudoaneurysm of internal carotid artery could cause massive epistaxis that requires a right clinical setting to diagnose, and embolization is the effective treatment to prevent mortality.Keywords: Internal carotid artery pseudoaneurysm, sphenoid sinuses trauma, massive epistaxis

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Multiple Cerebral Aneurysm - Case Report

Romanian Neurosurgery ◽

10.2478/romneu-2014-0037 ◽

2014 ◽

Vol 21 (3) ◽

pp. 279-282 ◽

Cited By ~ 1

Author(s):

C. Kakucs ◽

I. St. Florian

Keyword(s):

Case Report ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Ct Scan ◽

Cerebral Aneurysm ◽

Internal Carotid ◽

Neurological Status ◽

Posterior Communicating Artery ◽

Nuchal Rigidity ◽

Angio Ct

Abstract This 41-years-old female presented with somnolence, confusion and nuchal rigidity. Preoperative angio-CT scan showed two aneurysm located on both internal carotid artery (ICA) at the site of posterior communicating artery (PComA). During surgery we discovered another dilatation on the origin of left ophtalmic artery that proves to be an infundibullum. We clipped the two communicating posterior aneurysm from the left side and the ophtalmic infundibullum was wrapped. Seven days after surgery the neurological status was improved and she was transferred to the Neurological department.

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