Classification of Sphenoid Sinus Pneumatization: Relevance for Endoscopic Skull Base Surgery. (24th November 2014)

• Record Type: Journal Article
• Authors: Vaezi, Alec; Cardenas, Eugenio; Pinheiro‐Neto, Carlos; Paluzzi, Alessandro; Branstetter, Barton F.; Gardner, Paul A.; Snyderman, Carl H.; Fernandez‐Miranda, Juan C.
• Is Part Of: Laryngoscope. Volume 125:Number 3(2015:Mar.)
• Page Start: 577
• Page End: 581
• Publication Date: 2014-11-24
• Subjects: Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.24989
• Languages: English
• ISSNs: 0023-852X

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="lary24989-sec-0001" sec-type="section"> <title>Objectives/Hypothesis</title> <p>The goal of this study was to present a classification based on the degree of pneumatization of the sphenoid sinus in the coronal plane that can be used to instruct preoperative planning for endoscopic endonasal surgery (EES).</p> </sec> <sec id="lary24989-sec-0002" sec-type="section"> <title>Study Design</title> <p>Observational anatomical study.</p> </sec> <sec id="lary24989-sec-0003" sec-type="section"> <title>Methods</title> <p>The geometry of sphenoid sinus pneumatization was characterized (n = 204 hemisinus) on high‐resolution computed tomography scans, and its associations with the location of the foramen rotundum (FR) and the vidian canal (VC) were measured. Based on these findings, we propose a simple classification of pneumatization of the sphenoid sinus relevant for EES.</p> </sec> <sec id="lary24989-sec-0004" sec-type="section"> <title>Results</title> <p>The lateral recess of the sphenoid sinus was pneumatized lateral to the FR in the coronal plane in 54% of patients. The distance separating the FR and the VC correlated strongly with the depth of the lateral recess. Based on these findings, we propose three types of pneumatization: type I, where the pneumatization extends from the midline to the medial edge of the VC (25%); type II, where the pneumatization reaches the medial edge of the FR (39%); and type III, where the pneumatization extends beyond the medial border of the FR (37%).</p> </sec> <sec id="lary24989-sec-0005" sec-type="section"> <title>Conclusions</title> <p>The proposed sphenoid sinus pneumatization classification in the coronal plane is simple and reproducible. It predicts the distance between vidian and maxillary nerve, determines the size of the surgical window to access the middle cranial fossa transnasally, and instructs on the potential risk to neurovascular structures during surgery.</p> </sec> <sec id="lary24989-sec-0006" sec-type="section"> <title>Level of Evidence</title> <p>4 <italic>Laryngoscope</italic>, 125:577–581, 2015</p> </sec> </abstract>