Using Fixed Anatomical Landmarks in Endoscopic Skull Base Surgery

Harvey, Richard J.; Shelton, William; Timperley, Daniel; Debnath, Nick; Byrd, K. A.; Buchmann, Luke; Gallagher, Richard; Orlandi, Richard R.; Sacks, Raymond; Schlosser, Rodney J.

doi:10.2500/ajra.2010.24.3473

Cited by 35 publications

(46 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Unexpected complications are extremely stressful, so use this timeout regain your composure – allow your own heart rate to recover before rescrubbing and trying to define the site of the leak. It is essential to review the patient's anatomy endoscopically for reorientation, using fixed landmarks such as the floor of the orbit (the lowest point of the skull base is never below this), the face of sphenoid and height of the skull base at its lowest point posteriorly within the sphenoid, before aiming to identify the site of the leak. The most common sites of iatrogenic injury include the anterior ethmoid at the attachment of the medial turbinate, followed by the junction between ethmoid and sphenoid sinus, and these should be carefully examined.…”

Section: What Do I Do Now?mentioning

confidence: 99%

Up‐to‐date expert opinion referencing the best evidence available on intraoperative cerebrospinal fluid leak during endoscopic sinus surgery

Reefy¹,

Hopkins²

2013

Clinical Otolaryngology

View full text Add to dashboard Cite

Section: What Do I Do Now?mentioning

confidence: 99%

Up‐to‐date expert opinion referencing the best evidence available on intraoperative cerebrospinal fluid leak during endoscopic sinus surgery

Reefy¹,

Hopkins²

2013

Clinical Otolaryngology

View full text Add to dashboard Cite

“…Because of the increasing popularity of ESS and the growing risks posed by increasingly advanced approaches to the sinuses and their adjacent regions, many endoscopic and radiological studies have been conducted with the purpose of better understanding the anatomy and the potential reference points that can help guide surgeons during endoscopic procedures. 2,4,[6][7][8][9] Approaches to the posterior ethmoid and sphenoid sinuses are common procedures that offer significant risks during ESS. The major concern when entering these areas is the inadvertent breach of the skull base.…”

Section: Discussionmentioning

confidence: 99%

“…This region is not often affected by previous extensive inflammatory diseases or surgeries, which makes it a consistent reference point. 3,6,9 It is noteworthy that patients with inflammatory disorders, such as chronic rhinosinusitis with or without polyposis, were not excluded from the study because we believe that such disorders do not change the reference point. Thus, we conclude that the MOF can be used as a reference point during ESS.…”

Section: Discussionmentioning

confidence: 99%

Differentiation between Posterior Sinuses Using the Medial Orbital Floor as a Landmark

et al. 2016

View full text Add to dashboard Cite

This study aims to evaluate the difference in height between the floors of the posterior ethmoid and sphenoid sinuses with respect to the medial orbital floor (MOF) to confirm this difference as a landmark for identification of the posterior sinuses. It also aims to describe this difference regarding the type of pneumatization of the sphenoid sinus (conchal, presellar, and sellar). A cross-sectional study was conducted. The study was conducted at the Department of Radiology of Hospital de Clínicas de Porto Alegre, a tertiary care university hospital in Southern Brazil. A standardized and computerized analysis of 100 tomography scans of sinuses (200 sides), in patients older than 18 years, was carried out. Mean vertical distance (height) from the MOF to the floor of the posterior ethmoid and sphenoid sinuses was 0.72 ± 1.85 mm and 9.48 ± 3.81 mm, respectively. There was no statistically significant difference as compared with sex and side. We found conchal-type sphenoid sinus pneumatization in 1.5% ( = 3), presellar in 13.5% ( = 27), and sellar in 85% ( = 170), whereas the vertical distance between the MOF and the floor of the sphenoid sinus was 2.04 ± 0.81 in the conchal-type sinuses, 5.71 ± 2.49 in the presellar sinuses, and 10.21 ± 3.52 in the sellar sinuses. No sphenoid sinus showed its floor above the MOF, regardless of the type of pneumatization. The present study demonstrates that there is a difference between the floor of the posterior sphenoid and ethmoid sinuses in adults, which is more evident when the sphenoid sinus is well pneumatized. These data suggest that the difference in height between the floors of the sinus investigated in our study may be considered during endoscopic sinus surgery to guide adequate localization, but the surgeon should be aware of the type of pneumatization of the sphenoid sinus to use this landmark.

show abstract

“…The maxillary sinus roof, or alternatively, the floor of the orbit, has been found to always be below the level of the skull base. 15 Therefore, if one keeps the maxillary sinus roof in view while performing a skull base ethmoid dissection, one avoids injury to the skull base. In general, the ethmoid roof slopes superiorly in a posterior to anterior direction.…”

Section: Ethmoid Roofmentioning

confidence: 99%

“…It is 7 cm from the nasal sill at a 30 angle, 1 to 1.5 cm superior to the choanal roof, and 11 mm from the skull base. 15 It is identified just medial to the posteriorinferior aspect of the superior turbinate. In revision cases or in the absence of other common landmarks, the sphenoid ostium can be found at the level of the maxillary sinus ostium.…”

Section: Sphenoid Sinusmentioning

confidence: 99%