A new radiological classification for the risk assessment of anterior skull base injury in endoscopic sinus surgery

Baharudin Abdullah,Sng Weirong Joshua,Norasnieda Md Shukri,Mohd Ezane Aziz,Salina Husain,Shiun Chuen Chew,De Yun Wang,Kornkiat Snidvongs

doi:10.1038/s41598-020-61610-1

Baharudin Abdullah, Sng Weirong Joshua + Show 6 more

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https://doi.org/10.1038/s41598-020-61610-1

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Keros and Gera classifications are widely used to assess the risk of skull base injury during endoscopic sinus surgery. Although, both classifications are useful preoperatively to stratify risk of patients going for surgery, it is not practical to measure the respective lengths during surgery. In this study, we aimed to propose a new radiological classification (Thailand-Malaysia-Singapore (TMS)) to assess the anatomical risk of anterior skull base injury using the orbital floor (OF) as a reference. A total of 150 computed tomography images of paranasal sinuses (300 sides) were reviewed. The TMS classification was categorized into 3 types by measuring OF to cribriform plate and OF to ethmoid roof. Most patients were classified as TMS type 1, Keros type 2 and Gera class II, followed by patients classified as TMS type 3, Keros type 1 and Gera class 1. TMS has significant correlation with Keros classification (p < 0.05). There was no significant correlation between Keros and Gera classifications (p = 0.33) and between TMS and Gera classifications (p = 0.80). The TMS classification has potential to be used for risk assessment of skull base injury among patients undergoing ESS. It serves as an additional assessment besides the Keros and Gera classifications.

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Keros and Gera classifications are widely used to assess the risk of skull base injury during endoscopic sinus surgery
By measuring the angle formed by the lateral lamella of cribriform plate (CP) and the continuation of the horizontal plane passing through CP, the risk of intracranial entry was divided into 3 classes; class I (>80 degrees, low risk), class II (45 to 80 degrees, medium risk) and class III (
The angle that it articulates with CP determines the vertical length of lateral lamella and where there is a difference in right www.nature.com/scientificreports

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Introduction

Keros and Gera classifications are widely used to assess the risk of skull base injury during endoscopic sinus surgery. Both classifications are useful preoperatively to stratify risk of patients going for surgery, it is not practical to measure the respective lengths during surgery. Understanding the computed tomography of paranasal sinus (CT PNS) variations in every patient and equipping oneself with the diverse anatomical knowledge is a prerequisite prior to surgery The frequency of these variations may differ among different populations, but the orbital floor (OF) is always in constant position relative to the skull base that slopes posteriorly[2,3,4,5]. The aims of the study were to propose a new radiological classification to assess the risk of anterior skull base injury using the OF as a reference and compare it with the Keros and Gera classifications

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