Endoscopic Anterior Ethmoidal Artery Ligation: A Cadaver Study

Floreani, Stephen; Nair, Salil; Switajewski, Michael; Wormald, Peter John

doi:10.1097/01.mlg.0000221967.67003.1d

Cited by 99 publications

(65 citation statements)

References 11 publications

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“…The difference in thickness between the two was significant (Cochran and Cox t test, p < 0.05). In addition, the AEC presented a partial dehiscence in 33.3% of the cases, compared with defect rates of 11.4%, 8 16%, 16 and 66.7% 5 reported in the literature. The data demonstrated that the inferior bone wall's protection to the artery is weak, and the artery is more accessible -when distant from the ethmoid roof.…”

Section: Discussionmentioning

confidence: 82%

“…7,13,17 Floreani et al 16 measured the range of the posterolateral to anteromedial angle as 30 degrees to 45 degrees as it passed from the orbit to the anterior cranial fossa. Cankal et al 15 observed that AEC left the orbit at an angle of 12 to 50 degrees anteriorly, and the angle was superiorly 0 to 45 degrees and inferiorly 0 to 20 degrees on coronal images.…”

Section: Discussionmentioning

confidence: 99%

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Morphological Characteristics of the Anterior Ethmoidal Artery in Ethmoid Roof and Endoscopic Localization

Yang

Lü²,

Liao

et al. 2009

Skull Base

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Objectives: To provide anatomical data to help identify and locate the anterior ethmoidal artery (AEA) precisely during endoscopic procedures. Method: We dissected 15 adult cadaver heads, which provided 30 specimens, to study morphological characteristics, courses, and several types of variations. Results: We found the average diameter of the AEA to be 0.80 AE 0.24 mm. In 85.7% of the cases, the artery was seen between the second and third lamella. Other locations were over the roof of the frontal recess cells (10.7%) and the roof of the posterior ethmoid sinus (3.6%). The AEA ran parallel to the ethmoid roof and formed a slight curve. When viewed from the superior side, the angle formed by the long axis of the artery and the lamina papyracea was 60.5 degrees AE 16.4 degrees. In 83.3% of the cases, the anterior ethmoidal canal (AEC) was identified as a separate canal, and in 16.7% the canal was embedded in the ethmoid roof. In 10 of the 30 cases (33.3%), the AEC presented some degree of dehiscence. Conclusion: As a result of these dissections, we found that the AEA's course in the ethmoid roof varies. The morphological characteristics-that the AEA runs parallel to the ethmoid roof, forming a slight posterolateral to anteromedial curve as it passes from the orbit to the cribriform plate-are the most reliable factors used to identify the artery during surgery.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Morphological Characteristics of the Anterior Ethmoidal Artery in Ethmoid Roof and Endoscopic Localization

Yang

Lü²,

Liao

et al. 2009

Skull Base

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“…1,[3][4][5]8,9,[11][12][13][14]40,41 On the other hand, we found few papers describing studies using CT. 6,17,18,33,39 In assessing the anatomical landmarks for locating the anterior ethmoidal artery, we found that the medial notch of the orbit (anterior ethmoidal foramen) and the anterior ethmoidal sulcus on the lateral wall of the olfactory fossae were reliable parameters, since they were seen respectively in 100% and 98% of CT exams. Gotwald et al 17 assessed 40 coronal plane CT exams using similar technical settings as ours, and showed that the medial notch of the orbit and the anterior ethmoidal artery sulcus were found respectively in 95% and 84% of exams.…”

Section: Discussionmentioning

confidence: 99%

“…4,5,12,39 Injury of the anterior ethmoidal artery during endoscopic procedures may occur, with severe consequences. Preoperative knowledge of the course of the artery is essential to avoid complications; this important task belongs to CT.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 This artery irrigates the anterior ethmoidal cells and the frontal sinus; it also gives rise to the meningeal vessels in its course along the olfactory fossa, and also descends to the nasal fossa to irrigate the anterior thirds of the nasal septum and the lateral wall of the nose. 1,[3][4][5][6][7][8][9] The anterior ethmoidal artery is an anatomical landmark; its location is important for recognizing structures of difficult access (frontal sinus) and to define the superior limits in surgery (skull base). [10][11][12][13][14] Additionally, visualizing this artery makes it possible to recognize and treat causes of severe epistaxis.…”

Section: Introductionmentioning

confidence: 99%

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Avaliação da artéria etmoidal anterior pela tomografia computadorizada no plano coronal

Souza

Gregório

et al. 2009

Rev. Bras. Otorrinolaringol.

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The anterior ethmoidal artery (AEA) is an important point for frontal and ethmoid sinuses surgery. CT scans can identify landmarks to help the surgeon find the AEA. Aim: To identify the landmarks of the AEA on the orbital medial wall and on the lateral wall of the olfactory fossa. and to correlate the presence of supraorbital ethmoidal cells with spotting the anterior ethmoidal artery canal. Materials and Methods: Retrospective review of 198 direct coronal paranasal sinuses computed tomography (CT) scans from August to December, 2006. Results: Supraorbital pneumatization was seen in 35% (70 scans). The AEA canal was seen in 41% (81 scans). The anterior ethmoidal sulcus was seen in 98% (194 scans) and the anterior ethmoidal foramen was seen in all the scans (100%). Conclusion: The anterior ethmoidal foramen and the anterior ethmoidal sulcus were anatomical landmarks present in almost 100% of the scans studied. There was a correlation between the presence of supraorbital pneumatization and AEA canal visualization.

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Reliability of the supraorbital ethmoid cell vs Keros classification in predicting the course of the anterior ethmoid artery

Sharbel

White

et al. 2019

Int Forum Allergy Rhinol

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Background:We previously showed that the supraorbital ethmoid cell (SOEC) is a reliable landmark for identifying the anterior ethmoid artery (AEA). Recent data have suggested that Keros classification is also a dependable predictor. We aim to characterize the location of the AEA and its relation to the skull base in patients with and without SOEC using the Keros classification. Methods:Retrospective radiographic evaluation of computed tomography (CT) scans of 76 patients (40 with SOEC, 36 without) was conducted. Distance of AEA from skull base and prevalence of AEA outside of the skull base were measured on each side and compared between groups using the 2-sample t test and χ 2 test, respectively. Subgroup analysis was carried out based on the Keros classification.Results: Mean distance of AEA from the skull base was 1.32 ± 1.5 mm in patients with SOEC and 0.47 ± 1.08 mm in those without (p < 0.001). Prevalence of AEA outside of the skull base was 53.8% in those with SOEC and 18.1% in those without (p < 0.001). Comparing patients with SOEC to those without, AEA was found below the skull base in 30% vs 0% of cases with Keros type 1 (p = 0.45), 58% vs 14.5% with Keros type 2 (p < 0.001), and 60% vs 50% with Keros type 3 (p = 0.72). Conclusion:The presence of SOEC is associated with a higher prevalence of the AEA coursing below the level of the skull base in all Keros types, thus placing the artery at greater risk for injury. Careful surgical planning is needed to avoid potential orbital complications. C 2019 ARS-AAOA, LLC.

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Endoscopic Anterior Ethmoidal Artery Ligation: A Cadaver Study

Abstract: Endoscopic AEA ligation may be possible in some patients. The AEA should be in a mesentery for an effective clip to be placed and be associated with a dehiscence of the AEC. If the lateral lamella is classified as Keros grade 2 or 3, it is likely the AEC will be found in a mesentery.

Cited by 99 publications

References 11 publications

Morphological Characteristics of the Anterior Ethmoidal Artery in Ethmoid Roof and Endoscopic Localization

Morphological Characteristics of the Anterior Ethmoidal Artery in Ethmoid Roof and Endoscopic Localization

Avaliação da artéria etmoidal anterior pela tomografia computadorizada no plano coronal

Reliability of the supraorbital ethmoid cell vs Keros classification in predicting the course of the anterior ethmoid artery

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