Abstract
BackgroundSphenoid sinus is one of the most inaccessible paranasal sinuses. Advent of minimally invasive trans-nasal trans-sphenoidal approach over the past few years has provided an additional armament in the hands of skull-base surgeons to access pathologies adjoining base of skull. Close relationship of vital neurovascular structures with sphenoid sinus and variability of their protrusions into the sinus make these structures more vulnerable to iatrogenic trauma during surgical procedures. Preoperative assessment of such variations is imperative to avoid unintentional damage. The present study is a retrospective study conducted on CT scan records of 140 patients with an aim to evaluate prevalence of vital structures invaginating into sphenoid sinus and their clinical implications. The internal carotid artery (ICA), optic nerve (ON), maxillary nerve (MN), and Vidian nerve (VN) were assessed for protrusion into the sphenoid sinus and their dehiscence. Attachment of septum to protruding structures was also assessed. Data was statistically analyzed in the form of frequency and percentage to evaluate the prevalence of neurovascular invaginations into sphenoid sinus and their clinical implications.ResultsICA invagination was observed in 16% of males and 12% of females with males showing higher frequency on left side. Protrusion of ON was seen in 13% of males and 10% of females with higher prevalence in bilateral category. Twenty-four percent of study population had MN prominences which included 13% of males and 11% of females with higher reflection of bilateral presentation. Highest prevalence of 44% was observed in VN protrusions with equal distribution (22%) among each sex. Majority of these were bilaterally located. Dehiscence of ICA was observed in 9%, ON in 29%, MN in 10%, and VN in 30% of study population. Dehiscence brings these structures closure to sinus mucosa with increased risk of involvement in sinus disease. Septal attachment to ICA and ON was present in 7% and 15% cases respectively.ConclusionPreoperative assessment of anatomical configuration of sphenoid sinus and associated neurovascular structures is mandatory to minimize per-operative complications. This study provides statistical data on anatomical variations in neurovascular structures protruding into the sphenoid sinus, their dehiscence, and septal attachments in South Indian population.
Highlights
Sphenoid sinus is one of the most inaccessible paranasal sinuses
Variants included in the present study were internal carotid artery (ICA), optic nerve (ON), maxillary nerve (MN), and Vidian nerve (VN)
In recent years, trans-nasal, trans-sphenoidal endoscopic surgery has emerged as an important surgical modality for approaching areas beyond the limits of paranasal sinuses
Summary
Sphenoid sinus is one of the most inaccessible paranasal sinuses. Advent of minimally invasive transnasal trans-sphenoidal approach over the past few years has provided an additional armament in the hands of skullbase surgeons to access pathologies adjoining base of skull. Close relationship of vital neurovascular structures with sphenoid sinus and variability of their protrusions into the sinus make these structures more vulnerable to iatrogenic trauma during surgical procedures. Preoperative assessment of such variations is imperative to avoid unintentional damage. In case of hyper-pneumatization, bony coverings of protruding vessels and nerves may become very thin or even disappear, making these structures dehiscent and more vulnerable to iatrogenic trauma during surgery [5, 6]. Some of the septa may be attached to thin bony covering of vital neurovascular structures protruding into the cavity of sinus and in dehiscent cases directly to the nerves and vessels. The purpose of the present study is to assess prevalence of anatomical variations in interrelationship of the sphenoid sinus and neurovascular structures closely associated with it and their clinical significance
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