CT影像中筛前动脉与颅底的关系及在鼻窦炎手术中的意义

史慕寒; 王旻; 吴雨潇; 李辉; 黄诗恩; 吕志刚

doi:10.16098/j.issn.0529-1356.2020.05.005

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解剖学报 ›› 2020, Vol. 51 ›› Issue (5) : 664-669. DOI: 10.16098/j.issn.0529-1356.2020.05.005

解剖学与耳鼻喉科学

CT影像中筛前动脉与颅底的关系及在鼻窦炎手术中的意义

史慕寒¹王旻^1* 吴雨潇¹ 李辉¹ 黄诗恩¹ 吕志刚²

作者信息 +

Relationship between the anterior ethmoid artery and skull base in CT images and its significance in rhinosinusitis surgery

SHI Mu-han¹ WANG Min^1* WU Yu-xiao¹ LI Hui¹ HUANG Shi-en¹ Lü Zhi-gang²

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文章历史 +

摘要

目的通过CT影像探讨筛前动脉（AEA）与颅底的解剖关系及其在鼻窦炎手术中的意义。方法回顾性研究2017年1月～2017年8月共52例鼻窦炎患者，所有患者均行鼻窦CT扫描及重建，测量AEA与颅底的距离并分型，测量AEA至额嘴的距离，并研究其与AEA悬空的关系。记录眶上筛房（SOEC）的发生率并以卡方检验分析SOEC与AEA悬空的关系，测量筛板外侧板的深度并进行Keros分型，以 Spearman 相关系数分析Keros分型与AEA悬空的关系。结果 AEA在CT图像中辨别率为100%， Ⅰ型为AEA嵌于颅骨内，占 42.3%（44/104），Ⅱ型为AEA紧贴颅底，占18.3%（19/104），Ⅲ型为AEA悬空于筛窦内，占39.4%（41/104），即AEA的悬空率为39.4%，至颅底的平均距离为（3.8±1.5）mm。AEA至额嘴平均距离（14.1±2.2）mm，其距离在AEA悬空与非悬空组中差异无统计学意义（t=0.740，P>0.05）。在Keros分型中，Ⅰ型占51.9%（54/104），Ⅱ型占37.5%（39/104），Ⅲ型占10.6%（11/104）。Keros分型与AEA发生悬空之间的Spearman相关系数为0.505（P<0.001)，为中度正相关。SOEC发生率为17.3%（17/104），有SOEC的患者与无SOEC的患者的AEA悬空发生率差异存在统计学意义（χ2=4.3287，P<0.05）。结论当SOEC存在或Keros分型级别较高时，AEA的悬空率明显升高，术前进行CT影像学检查可以识别颅底解剖情况，明确AEA与颅底的位置关系，进而降低术中AEA的损伤风险。

Abstract

Objective To investigate the anatomical relationship between the anterior ethmoid artery (AEA) and skull base and its significance in rhinosinusitis surgery. Methods A retrospective study was conducted in 52 patients with sinusitis from January 2017 to August 2017. All patients underwent CT scan and the images were reconstructed. The distance between AEA and the skull base was measured and AEAs were classified. The distance from the AEA to the frontal beak was measured and its relationship with the AEA suspension was studied. The prevalence of supraorbital ethmoid cell (SOEC) was recorded the relationship between SOEC and AEA suspension was analyzed by Chi-square test. The depth of lateral lamella of the cribriform plate was measured and the Keros classification was used to classify the sinuses. Spearman’s rank correlation coefficient was used to analyze the relationship between Keros classification and AEA suspension. Results The recognition rate of AEA in CT images was 100%. Type Ⅰ AEA was embedded in the skull, accounting for 42.3% (44/104). Type Ⅱ AEA protruded at the skull base, accounting for 18.3% (19/104). Type Ⅲ AEA was suspended in the ethmoid sinus, accounting for 39.4% (41/104), that is, the AEA suspension rate was 39.4%. The average distance to the skull base was （3.8 ± 1.5） mm. The average distance from AEA to beak was (14.1 ± 2.2) mm, and the difference of the distance in the AEA suspended and non-suspended groups was not statistically significant (t=0.740, P>0.05). In the Keros classification, type Ⅰ accounted for 51.9% (54/104), type Ⅱ for 37.5% (39/104), and type Ⅲ for 10.6% (11/104). The spearman correlation coefficient between Keros classification and AEA suspension was 0.505 (P<0.001), which meaned they were moderately positively related. The prevalence of SOEC was 17.3% (17/104). There was a statistically significant difference of AEA suspension rate between patients with SOEC and patients without SOEC(χ2=4.287, P<0.05). Conclusion When SOEC is present or the level of Keros classification is high, the suspension rate of AEA increased significantly. Preoperative CT imaging can identify the anatomy of the skull base, and clarify the positional relationship between AEA and the skull base, and then reduce the risk of AEA injury during surgery.

导出引用

史慕寒王旻吴雨潇李辉黄诗恩吕志刚. CT影像中筛前动脉与颅底的关系及在鼻窦炎手术中的意义[J]. 解剖学报. 2020, 51(5): 664-669 https://doi.org/10.16098/j.issn.0529-1356.2020.05.005

SHI Mu-han WANG Min WU Yu-xiao LI Hui HUANG Shi-en Lü Zhi-gang. Relationship between the anterior ethmoid artery and skull base in CT images and its significance in rhinosinusitis surgery[J]. Acta Anatomica Sinica. 2020, 51(5): 664-669 https://doi.org/10.16098/j.issn.0529-1356.2020.05.005

中图分类号： R762

参考文献

［1］ Wormald PJ, Hoseman W, Callejas C, et al. The international frontal sinus anatomy classification (ifac) and classification of the extent of endoscopic frontal sinus surgery (EFSS)［J］. Int Forum Allergy Rhinol, 2016, 6(7):677-696.
［2］ Wang M, Yuan F, Qi WW, et al. Anatomy, classification of intersinus septal cell and its clinical significance in frontal sinus endoscopic surgery in Chinese subjects［J］. Chin Med J (Engl), 2012, 125(24):4470-4473.
［3］ Shi MH, Wang M, Li H, et al. The CT image features of ethmomaxillary sinus and their significance in endoscopic surgery［J］. Chinese Journal of Otorhinolaryngology Head and Neck Surgery，2019, 54(11): 813-818. (in Chinese)
史慕寒, 王旻, 李辉, 等. 筛上颌窦气房的CT影像特点及其在上颌窦手术中的意义［J］. 中华耳鼻咽喉头颈外科杂志, 2019, 54(11): 813-818.
［4］ Lannoy-Penisson L, Schultz P, Riehm S, et al. The anterior ethmoidal artery: radio-anatomical comparison and its application in endonasal surgery［J］. Acta Otolaryngol, 2007, 127(6):618-622
［5］ Keros P. On the practical value of differences in the level of the lamina cribrosa of the ethmoid［J］. Z Laryngol Rhinol Otol, 1962, 41:809-813.
［6］ Joshi AA, Shah KD, Bradoo RA. Radiological correlation between the anterior ethmoidal artery and the supraorbital ethmoid cell［J］. Indian J Otolaryngol Head Neck Surg,2010, 62(3):299-303.
［7］ Zhu L, Wu HB, Fang GL, et al. Value of three-dimensional interactive localization of the anterior ethmoidal canals in minimally invasive nasal surgery［J］. Chinese Journal of Minimally Invasive Surgery, 2009,9(12):1105-1107. (in Chinese)
朱丽, 邬海博, 房高丽, 等. 筛前动脉三维交互观察在鼻微创手术中的定位意义［J］. 中国微创外科杂志, 2009, 9(12):1105-1107.
［8］ Pan ZhY, Qian XJ, Zhai RY, et al. Anatomical study of the ethmoidal canal by multislice CT and its clinical significance［J］. Chinese Journal of Medical Imaging Technology, 2006, 22(8):1185-1188. (in Chinese)
潘振宇, 钱晓军, 翟仁友, 等. 筛动脉管的CT影像解剖学研究及其临床意义［J］. 中国医学影像技术, 2006, 22(8):1185-1188.
［9］ Ding J, Li GY, Zhang XP, et al. Initial evalution of anterior ethmoid artery by 320-row CT cerebral angiography: contrast study with DSA［J］. Chinese Journal of Clinicians(Electronic Edition), 2011,5(13):3746-3750. (in Chinese)
丁娟, 李国英, 张绪平, et al. 320排CT血管成像评价筛前动脉的初步探讨［J］.中华临床医师杂志(电子版),2011,5(13):3746-3750.
［10］ Simmen D, Raghavan U, Briner HR, et al. The surgeon’s view of the anterior ethmoid artery［J］. Clin Otolaryngol, 2006, 31(3): 187-191.
［11］ Erdogmus S, Govsa F. The anatomic landmarks of ethmoidal arteries for the surgical approaches［J］. J Craniofac Surg, 2006, 17(2):280-285.
［12］ Moon HJ, Kim HU, Lee JG, et al. Surgical anatomy of the anterior ethmoidal canal in ethmoid roof［J］. Laryngoscope, 2001, 111(5):900-904.
［13］ Mcdonald SE, Robinson PJ, Nunez DA. Radiological anatomy of the anterior ethmoidal artery for functional endoscopic sinus surgery［J］. J Laryngol Otol, 2008, 122(3):264-267.
［14］ Abdullah B, Lim EH, Mohamad H, et al. Anatomical variations of anterior ethmoidal artery at the ethmoidal roof and anterior skull base in Asians［J］. Surg Radiol Anat, 2019, 41(5):543-550.
［15］ Araujo Filho BC, Weber R, Pinheiro Neto CD, et al. Endoscopic anatomy of the anterior ethmoidal artery: a cadaveric dissection study［J］. Braz J Otorhinolaryngol, 2006, 72(3):303-308.
［16］ Zhang RX, Tian H, Ma YX. Computed tomography assessment of skull base height before endoscopic sinus surgery［J］. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(5):75-77. (in Chinese)
张汝祥, 田昊, 马有祥. 鼻内镜鼻窦手术前筛窦颅底高度的CT评估价值［J］. 山东大学耳鼻喉眼学报, 2018, 32(5):75-77.
［17］ Skorek A, Tretiakow D, Szmuda T, et al. Is the Keros classification alone enough to identify patients with the‘dangerous ethmoid’? An anatomical study［J］. Acta Otolaryngol, 2017, 137(2):196-201.
［18］ Poteet PS, Cox MD, Wang RA, et al. Analysis of the relationship between the location of the anterior ethmoid artery and keros classification［J］. Otolaryngol Head Neck Surg, 2017, 157(2):320-324.
［19］ Yenigun A, Goktas SS, Dogan R, et al. A study of the anterior ethmoidal artery and a new classification of the ethmoid roof (Yenigun classification)［J］. Eur Arch Otorhinolaryngol, 2016, 273(11):3759-3764.
［20］ Jang DW, Lachanas VA, White LC, et al. Supraorbital ethmoid cell: a consistent landmark for endoscopic identification of the anterior ethmoidal artery［J］. Otolaryngol Head Neck Surg, 2014, 151(6):1073-1077.
［21］ Tran LV, Ngo NH, Psaltis AJ. A radiological study assessing the prevalence of frontal recess cells and the most common frontal sinus drainage pathways［J］. Am J Rhinol Allergy, 2019, 33(3): 323-330.
［22］ Li M, Sharbel DD, White B, et al. Reliability of the supraorbital ethmoid cell vs Keros classification in predicting the course of the anterior ethmoid artery［J］. Int Forum Allergy Rhinol, 2019, 9(7):821-824.