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

SHI Mu-Han; WANG Min; WU Yu-Xiao; LI Hui

doi:10.16098/j.issn.0529-1356.2020.05.005

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Acta Anatomica Sinica ›› 2020, Vol. 51 ›› Issue (5) : 664-669. DOI: 10.16098/j.issn.0529-1356.2020.05.005

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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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.

Key words

Anterior ethmoidal artery / Skull base / Rhinosinusitis / Supraorbital ethmoid cell / Keros classification / Anatomy / Human

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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

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