Radiological and Endoscopic Study of the Anatomical Landmark to Localise the Anterior Ethmoidal Artery in Endoscopic Sinus Surgery
Keywords:
Radiological study, Endoscopic sinus surgery, Anatomical landmark,, Anterior ethmoidal arteryAbstract
Introduction: The anterior ethmoidal artery (AEA) is an important anatomical structure duringendoscopic sinus surgery (ESS) due to the risk of injury. Preoperative identification of landmarks
correlating with AEA location could help reduce complications. This study aims to determine
anatomical variations affecting the AEA course concerning the skull base.
Methods: A retrospective review was conducted of 50 patients who underwent ESS.
Preoperative coronal CT scans were analysed for supraorbital ethmoid cells (SOEC), suprasellar
cells (SBC), and Keros classification of olfactory fossa depth. Radiological AEA location relative
to the skull base was recorded. Intraoperative videos were reviewed to correlate findings with
radiology.
Results: SOEC were present on 24 right and 28 left sides. SBC were present in 39 right and 33
left sides. The most common Keros types were right type 1 (31) and left type 1 (27).
Radiologically, AEA was within the skull base on 32 right and 27 left sides. Intraoperative
correlation showed a higher incidence of AEA below the skull base with SOEC/SBC presence and
more profound Keros types. The relationship between anatomical variations and AEA location
was statistically significant (p<0.05).
Conclusion: This study demonstrates that anatomical variations, including SOEC, SBC, and
Keros classification, influence the course of the AEA relative to the skull base. Preoperative
identification using these landmarks on CT may help surgeons localise and protect the AEA during
ESS, thus reducing the risks of injury. More extensive prospective studies are needed to validate
these findings.
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