Anatomical variations of intra-sphenoid sinus septations in a sample of Kashmiri population: a non-contrast computed tomography study

Abstract

Background: The sphenoid sinus shows multitude of variations in pneumatization, size and pattern of septations leading to differences in its segmentation. Pre-operative knowledge of their attachment especially to posterolateral bony walls covering vital structures is of utmost importance for a safe trans-sphenoidal approach for various surgical procedures involving skull base. Non-contrast computed tomography (NCCT) with its ability to provide multiplanar reformations (MPR) with sharp algorithms is now a reference standard for visualization of these intra-sphenoid sinus septations preoperatively. The objective of this study was to determine the number and attachment of intra-sphenoid sinus septations in a Kashmiri population sample.Methods: NCCT head images of 591 patients in the age range of 16 to 75 years were analyzed retrospectively. Individuals with age less than 16 years, previous surgery involving skull base/sphenoid sinus, trauma causing hem sinus/fractures around skull base or having space occupying lesions around skull base/sphenoid sinus were excluded from the study. On the CT workstation multi-planar coronal, sagittal and axial reconstructions were performed and subsequently examined.Results: The age range was 16 to 75 years with mean age of 43.56 years of which 453 (76.6%) were males and 138 (23.4%) were females. Single intra-sphenoid septation was the most common anatomic variant in present study (79.7%) being complete in 71.7% and partial or incomplete in 8% of the examined subjects. Double septa were found in 11% inpresent study and more than 2 septae in 3.4%. After sellar attachment (51%) the next most common site of attachment was to the carotid canal (29.5%) (23% to left ICA and 6.5% to the right ICA).Conclusions: Intricate knowledge about sphenoid sinus, its pneumatization and anatomical variations in intra-sphenoid sinus septations and its relationship with the surrounding vital structures is of utmost importance before performing any endoscopic/open surgery involving skull base via trans-sphenoidal approach. The present study shows that a significant percentage of septal attachment to the carotid canal makes main sphenoidal septum as not so reliable landmark for endoscopic procedures as used to be in the pre-imaging era. Thus, preoperative CT is mandatory to avoid injuries to para-sellar neurovascular and glandular structures.

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“…Thereafter, pneumatization begins and proceeds posteriorly, leading to a visible definitive cavity at puberty (Fasunla et al, 2012;Wani et al, 2019).…”

“…The variant patterns of development and pneumatization of the SS have led to asymmetry in its shape, size, and septation (Wani et al, 2019).…”

“…The SS septa may insert onto the neighbouring ICA canal or optic nerve canal (Secchi et al, 2018;Ismail et al, 2018). Studies in literature have documented the variation in the number, location and attachment of the SS septa in various populations (Famurewa et al, 2018;Wani et al, 2019;Degaga et al, 2020;Dziedzic et al, 2020;Singh et al, 2022;).…”

“…the reports from Turkey(Aksoy et al, 2017;Wani et al, 2019). The awareness of multiple SS septa is important, since they are commonly seen in acromegaly(Dziedzic et al, 2020).…”

Variant septation of the sphenoid sinus in adult Nigerians: CT study

“…the reports from Turkey(Aksoy et al, 2017;Wani et al, 2019). The awareness of multiple SS septa is important, since they are commonly seen in acromegaly(Dziedzic et al, 2020).…”