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11.05.2020 | Teaching Anatomy

Sphenoid sinuses: pneumatisation and anatomical variants—what the radiologist needs to know and report to avoid intraoperative complications

verfasst von: Michaela Cellina, Daniele Gibelli, Chiara Floridi, Tahereh Toluian, Carlo Valenti Pittino, Carlo Martinenghi, Giancarlo Oliva

Erschienen in: Surgical and Radiologic Anatomy | Ausgabe 9/2020

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Abstract

Purpose

Sphenoid sinuses are pneumatised structures, placed in the body of the sphenoid bone, with highly variable morphology. The strict relationships with vascular and nervous structures determine the importance of their anatomical variants in otorhinolaryngology and neurosurgery; a precise understanding of the complex anatomy and anatomic variations of these structures is pivotal for radiological diagnosis of paranasal sinuses pathology and for surgical planning, to avoid potential complications.

Our aim is to describe the anatomical variants of sphenoid sinuses, and to help general radiologists and specialists in endoscopic surgery in becoming familiar with these sensitive anatomical structures.

Methods

A literature search of PubMed and Embase (Elsevier) databases was performed using the keywords “sphenoid sinus” and “anatomy, “sphenoid sinus” and “anatomic variants”, “sphenoid sinus”, and “anatomic variations”.

Results

We described the anatomical variants of the sphenoid sinuses anatomy, according to their size, shape, degree of pneumatisation, protrusion of anatomical structures into their lumen, superimposition of ethmoid cells (Onodi cells), and presence of accessory septations

Conclusion

The information provided by this study may help in the identification and description of the anatomical variations of the sphenoid sinuses and their relationship to neurovascular structures.

Abdullah BJ, Arasaratnam A, Kumar G, Gopala K (2001) The sphenoid sinuses: computed tomographic assessment of septation, relationship to the internal carotid arteries and sidewall thickness in the Malaysian population. J HK Coll Radiol 4:185–188

Adibelli ZH, Songu M, Adibelli H (2011) Paranasal sinus development in children: a magnetic resonance imaging analysis. Am J Rhinol Allergy 25(1):30–35. https://doi.org/10.2500/ajra.2011.25.3552 CrossRefPubMed

Anusha B, Baharudin A, Philip R, Harvinder S, Shaffie BM, Ramiza RR (2015) Anatomical variants of surgically important landmarks in the sphenoid sinus: a radiologic study in Southeast Asian patients. Surg Radiol Anat 37(10):1183–1190. https://doi.org/10.1007/s00276-015-1494-8 CrossRefPubMed

Arslan H, Aydinhoglu A, Bozkurt M, Egeli E (1999) Anatomical variations of the paranasal sinuses: CT examination for endoscopic sinus surgery. Auris Nasus Larynx 26(39–48):16. https://doi.org/10.1016/s0385-8146(98)00024-8 CrossRef

Banna M, Olutola PS (1983) Patterns of pneumatization and septation of the sphenoidal sinus. J Can Assoc Radiol 34(4):291–293PubMed

Başak S, Karaman CZ, Akdilli A, Mutlu C, Odabasi O, Erpek G (1998) Evaluation of some important anatomical variations and dangerous areas of the paranasal sinuses by CT for safer endonasalsurgery. Rhinology 36:162–167PubMed

Bolger WE, Butzin CA, Parsons DS (1991) Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope 101:56–64. https://doi.org/10.1288/00005537-199101000-00010 CrossRefPubMed

Cohen O, Warman M, Fried M et al (2018) Volumetric analysis of the maxillary, sphenoid and frontal sinuses: a comparative computerized tomography based study. Auris Nasus Larynx 45(1):96–102. https://doi.org/10.1016/j.anl.2017.03.003 CrossRefPubMed

Dal Secchi MM, Dolci RLL, Teixeira R, Lazarini PR (2018) An analysis of anatomic variations of the sphenoid sinus and its relationship to the internal carotid artery. Int Arch Otorhinolaryngol 22(2):161–166. https://doi.org/10.1055/s-0037-1607336 CrossRef

10.

Elwany S, Elsaeid I, Thabert H (1999) Endoscopic anatomy of sphenoid sinus. J Laryngol Otol 113:122–126CrossRef

11.

Fernandez-Miranda JC, Prevedello DM, Madhok R, Morera V, Barges-Coll J, Reineman K, Snyderman CH, Gardner P, Carrau R, Kassam AB (2009) Sphenoid septations and their relationship withinternal carotid arteries: anatomical and radiological study. Laryngoscope 119(10):1893–1896. https://doi.org/10.1002/lary.20623 CrossRefPubMed

12.

Fuji K, Chambers A, Rhoton J (1979) Neurovascular relationships of the sphenoid sinus: a microsurgical study. J Neurosurg 50:31–39. https://doi.org/10.3171/jns.1979.50.1.003 CrossRef

13.

Gibelli D, Cellina M, Gibelli S et al (2018) Volumetric assessment of sphenoid sinuses through segmentation on CT scan. Surg Radiol Anat 40(2):193–198. https://doi.org/10.1007/s00276-017-1949-1 CrossRefPubMed

14.

Gibelli D, Cellina M, Gibelli S, Cappella A, Oliva AG, Termine G, Dolci C, Sforza C (2019) Relationship between sphenoid sinus volume and protrusion of internal carotid artery and optic nerve: a 3D segmentation study on maxillofacial CT-scans. Surg Radiol Anat 41(5):507–512. https://doi.org/10.1007/s00276-019-02207-w CrossRefPubMed

15.

Cappella A, Gibelli D, Cellina M, Mazzarelli D, Oliva AG, De Angelis D, Sforza C, Cattaneo C (2019) Three-dimensional analysis of sphenoid sinus uniqueness for assessing personal identification: a novel method based on 3D–3D superimposition. Int J Legal Med 133(6):1895–1901CrossRef

16.

Gibelli D, Cellina M, Gibelli S, Oliva AG, Termine G, Sforza C (2017) Anatomical variants of sphenoid sinuses pneumatization: a CT scan study on a Northern Italian population. Radiol Med 122(8):575–580. https://doi.org/10.1007/s11547-017-0759-1 CrossRefPubMed

17.

Gibelli D, Cellina M, Gibelli S, Panzeri M, Oliva AG, Termine G, Sforza C (2018) Sella turcica bridging and ossified carotico-clinoid ligament: correlation with sex and age. Neuroradiol J 3(3):299–304. https://doi.org/10.1177/1971400917751036 CrossRef

18.

Gibelli D, Cellina M, Gibelli S, Cappella A, Oliva AG, Termine G, Sforza C (2019) Relationship between sphenoid sinus volume and accessory septations: a 3D assessment of risky anatomical variants for endoscopic surgery. Anat Rec (Hoboken). https://doi.org/10.1002/ar.24245 CrossRef

19.

Güldner C, Pistorius SM, Diogo I et al (2012) Analysis of pneumatization and neurovascular structures of the sphenoid sinus using cone-beam tomography (CBT). Acta Radiol 53(2):214–219. https://doi.org/10.1258/ar.2011.110381 CrossRefPubMed

20.

Gupta T, Aggarwal A, Sahni D (2003) Anatomical landmarks for locating the sphenoid ostium during endoscopic endonasal approach: a cadaveric study. Surg Radiol Anat 35(2):137–142. https://doi.org/10.1007/s00276-012-1018-8 CrossRef

21.

Haetinger RG, Navarro JAC, Liberti EA (2006) Basilar expansion of the human sphenoidal sinus: an integrated anatomical and computerized tomography study. Eur Radiol 16(9):2092–2099. https://doi.org/10.1007/s00330-006-0208-3 CrossRefPubMed

22.

Hamid O, Fiky LE, Hassan O et al (2008) Anatomic variations of the sphenoid sinus and their impact on trans-sphenoid pituitary surgery. Skull base 18(1):9–15. https://doi.org/10.1055/s-2007-992764 CrossRefPubMedPubMedCentral

23.

Hammer G, Radberg C (1961) The sphenoidal sinus. An anatomical and roentgenologic study with reference to transsphenoid hypophysectomy. Acta Radiol 56:401–422CrossRef

24.

Hewaidi GH, Omami GM (2008) Anatomical variation of sphenoid sinus and related structures in Libyan population: CT scan study. Libyan J Med 3(3):128–133. https://doi.org/10.4176/080307 CrossRefPubMedPubMedCentral

25.

Hiremath SB, Gautam AA, Sheeja K, Benjamin G (2018) Assessment of variations in sphenoid sinus pneumatization in Indian population: a multidetector computed tomography study. Indian J Radiol Imaging 28(3):273–279. https://doi.org/10.4103/ijri.IJRI_70_18 CrossRefPubMedPubMedCentral

26.

Idowu OE, Balogun BO, Okoli CA (2009) Dimensions, septation, and pattern of pneumatization of the sphenoidal sinus. Folia Morphol 68(4):228–232

27.

Jaworek-Troc J, Zarzecki M, Mroz I, Troc P, Chrzan R, Zawilinski J, Walocha J, Urbanik A (2018) The total number of septa and antra in the sphenoid sinuses–evaluation before the FESS. Folia Med Cracov 3:67–81

28.

Jiang RS, Liang KL (2014) Image-guided sphenoidotomy in revision functional endoscopic sinus surgery. Allergy Rhinol (Providence) 5(3):116–119. https://doi.org/10.2500/ar.2014.5.0093 CrossRef

29.

Kantarci M, Karasen RM, Alper F, Onbas O, Okur A, Karaman A (2004) Remarkable anatomic variantions in paranasal sinus region and their clinical importnace. Eur J Radiol 50(3):296–302. https://doi.org/10.1016/j.ejrad.2003.08.012 CrossRefPubMed

30.

Kayalioglu G, Erturk M, Varol T (2005) Variations in sphenoid sinus anatomy with special emphasis on pneumatization and endoscopic anatomic distances. Neurosciences 10(1):79–84PubMed

31.

Kazkayasi M, Karadeniz Y, Arikan OK (2005) Anatomic variations of the sphenoid sinus on computed tomography. Rhinology 43(2):109–114PubMed

32.

Keast A, Yelavich S, Dawes P, Lyons B (2008) Anatomical variations of the paranasal sinuses in Polynesian and New Zealand European computerized tomography scans. Otolaryngol Head Neck Surg 139(2):216–221. https://doi.org/10.1016/j.otohns.2008.05.014 CrossRefPubMed

33.

Kim J, Song SW, Cho JH, Chang KH, Jun BC (2010) Comparative study of the pneumatization of the mastoid air cells and paranasal sinuses using three-dimensional reconstruction of computed tomography scans. Surg Radiol Anat 32(6):593–599. https://doi.org/10.1007/s00276-009-0618-4 CrossRefPubMed

34.

Lauri C, Carter LC, Pfaffenbach A et al (1999) Hyperaeration of the sphenoid sinus: cause for concern? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 88:506–510. https://doi.org/10.1016/s1079-2104(99)70071-5 CrossRef

35.

Leclerc JE, Leclerc JT (2009) Sphenoid sinus development in choanal atresia. Int J Pediatr Otorhinolaryngol 73(12):1746–1750. https://doi.org/10.1016/j.ijporl.2009.09.031 CrossRefPubMed

36.

Lee DH, Shin JH, Lee DC (2012) Three-dimensional morphometric analysis of paranasal sinuses and mastoid air cell system using computed tomography in pediatric population. Int J Pediatr Otorhinolaringol 76(11):1642–1646. https://doi.org/10.1016/j.ijporl.2012.07.037 CrossRef

37.

Li SL, Wang ZC, Xian JF (2010) Study of variations in adult sphenoid sinus by multislice spiral computed tomography. Zhonghua Yi Xue Za Zhi 90(31):2172–2176PubMed

38.

Lu Y, Pan J, Qi S et al (2011) Pneumatization of the sphenoid sinus in Chinese: the differences from Caucasian and its application in the extended transsphenoidal approach. J Anat 219(2):132–142. https://doi.org/10.1111/j.1469-7580.2011.01380 CrossRefPubMedPubMedCentral

39.

Lupascu M, Comsa GI, Zainea V (2014) Anatomical variations of the sphenoid sinus-a study of 200 cases. ARS Medica Tomitana 2:57–62. https://doi.org/10.2478/arsm-2014-0011 CrossRef

40.

Mafee MF, Chow JM, Meyers R (1993) Functional endoscopic sinus surgery: anatomy, CT screening, indications and complications. AJR 160(4):735–744. https://doi.org/10.2214/ajr.160.4.8456654 CrossRefPubMed

41.

Anniko M, Bernal-Sprekelsen M, Bonkowsky V, Bradley P, Iurato S (2010) Otorhinolaryngology Head and Neck Surgery. Springer, New YorkCrossRef

42.

Meybodi AT, Vigo V, Benet A (2017) The Onodi Cell: an Anatomical Illustration. Word Neurosurgery 103:950.e5–950.e6. https://doi.org/10.1016/j.wneu.2017.05.012 CrossRef

43.

Mutlu C, Unlu HH, Goktan C, Tarhan S, Egrilmez M (2001) Radiologic anatomy of the sphenoid sinus for intranasal surgery. Rhinology 39(3):128–132PubMed

44.

Oliveira JM, Alonso MB, de Sousa E, Tucunduva MJ, Fuziy A, Scocate AC, Costa AL (2016) Volumetric study of sphenoid sinuses: anatomical analysis in helical computed tomography. Surg Radiol Anat 39(4):367–374. https://doi.org/10.1007/s00276-016-1743-5 CrossRefPubMed

45.

Omami G, Hewaidi G, Mathew R (2011) The neglected anatomical and clinical aspects of pterygoid canal: CT scan study. Surg Radiol Anat 33:697–702. https://doi.org/10.1007/s00276-011-0808-8 CrossRefPubMed

46.

Orlandi RR, Smith B, Shah L et al (2012) Endoscopic verification of the sphenoid sinus. Int Forum Allergy Rhinol 2(1):16–19. https://doi.org/10.1002/alr.20096 CrossRefPubMed

47.

Pandolfo I, Gaeta M, Blandino I, Longo M (1987) The radiology of pterygoid canal: normal and pathologic findings. AJNR Am J Neuroradiol 8(3):479–483PubMed

48.

Park IH, Song JS, Choi H et al (2010) Volumetric study in the development of paranasal sinuses by CT imaging in Asian: a pilot study. Int J Pediatr Otorhinolaryngol 74(12):1347–1350. https://doi.org/10.1016/j.ijporl.2010.08.018 CrossRefPubMed

49.

Perez-Pinas I, Sabate J, Carmona A, Catalina-Herrera CJ, Jimenez-Castellanos J (2000) Anatomical variations in the human paransal sinus region studied by CT. J Anat 197(Pt 2):221–227. https://doi.org/10.1046/j.1469-7580.2000.19720221.x CrossRefPubMedPubMedCentral

50.

Pirinc B, Fazliogullari Z, Guler I, Unver Dogan N, Uysal II, Karabulut AK (2019) Classification and volumetric study of the sphenoid sinus on MDCT images. Eur Arch Otorhinolaryngol 276(10):2887–2894. https://doi.org/10.1007/s00405-019-05549-8 CrossRefPubMed

51.

Pirner S, Tingelhoff K, Wagner T, Westphal R, Rilk M, Wahl FM, Bootz F, Eichhorn KW (2009) CT-based manual segmentation and evaluation of paranasal sinuses. Eur Arch Otorhinolaryngol 266:507–518. https://doi.org/10.1007/s00405-008-0777-7 CrossRefPubMed

52.

Rahmati A, Ghafari R, AnjomShoa MA (2016) Normal variations of sphenoid sinus and the adjacent structures detected in cone beam computed tomography. J Dent Shiraz 17(1):32–37PubMedPubMedCentral

53.

Ramakrishnan VR, Suh JD, Lee JY, O’Malley Jr OBW, Grady MS, Palmer JN (2013) Sphenoid sinus anatomy and suprasellar extension of pituitary tumors. J Neurosurg 119(3):669–674. https://doi.org/10.3171/2013.3.JNS122113 CrossRefPubMed

54.

Reittner P, Doerfler O, Goritschnig T et al (2001) Magnetic resonance imaging patterns of the development of the sphenoid sinus: a review of 800 patients. Rhinology 39(3):121–124PubMed

55.

Rereddy SK, Johnson DM, Wise SK (2014) Markers of increased aeration in the paranasal sinuses and along the skull base: association between anatomical variants. Am J Rhinol Allergy 28(6):477–482. https://doi.org/10.2500/ajra.2014.28.4086 CrossRefPubMed

56.

Sanchez-Fernandez JM, Anta Escuredo JA, Sanchez Del Rey A, Santaolalla Montoya F (2000) Morphometric study of the paranasal sinuses in normal and pathological conditions. Acta Otolaryngol 120(2):273–278CrossRef

57.

Sareen D, Agarwal AK, Kaul JM et al (2005) Study of sphenoid sinus anatomy in relation to endoscopic surgery. Int J Morphol 23(3):261–266. https://doi.org/10.4067/S071795022005000300012 CrossRef

58.

Scuderi AJ, Harnsberger HR, Boyer RS (1993) Pneumatization of the paranasal sinuses: normal features of importance to the accurate interpretation of CT scans and MR images. AJR Am J Roentgenol 160(5):1101–1104. https://doi.org/10.2214/ajr.160.5.8470585 CrossRefPubMed

59.

Sheikh BY, Zahran MF (2006) Radiological anatomy of the sella turcica and sphenoid sinus. Pan Arab J Neurosurg 10(1):46–49

60.

Sirikci A, Bayazit YA, Bayram M, Mumbuc S, Gungor K, Kanlikama M (2000) Variations of sphenoid and related structures. Eur Radiol 10:844–848. https://doi.org/10.1007/s003300051016 CrossRefPubMed

61.

Som PM, Lawson W, Fatterparker GM et al (2011) Embryology, anatomy, physiology and imaging of the sinonasal cavities. In: Som PM, Curtin HD (eds) Head and neck imaging, 5th edn. Elsevier Health Sciences, St Louis

62.

Spektor S, Dotan S, Mizrahi CJ (2013) Safety of drilling for clinoidectomy and optic canal unroofing in anterior skull base surgery. Acta Neurochir 155:1017–1024. https://doi.org/10.1007/s00701-013-1704-2 CrossRefPubMed

63.

Štoković N, Trkulja V, Dumić-Čule I, Čuković-Bagić I, Lauc T, Vukičević S, Grgurević L (2016) Sphenoid sinus types, dimensions and relationship with surrounding structures. Ann Anat 203:69–76. https://doi.org/10.1016/j.aanat.2015.02.013 CrossRefPubMed

64.

Thanaviratananich S, Chaisiwamongkol K, Kraitrakul S et al (2003) The prevalence of an Onodi cell in adult Thai cadavers. Ear Nose Throat J 82(3):200–204CrossRef

65.

Unal B, Bademci G, Bilgili YK, Batay F, Avci E (2006) Risky anatomic variations of sphenoid sinus for surgery. Surg Radiol Anat 28:195–201. https://doi.org/10.1007/s00276-005-0073-9 CrossRefPubMed

66.

Vaezi A, Cardenas E, Pinheiro-Neto C, Paluzzi A, Branstetter BF 4th, Gardner PA et al (2015) Classification of sphenoid sinus pneumatization: relevance for endoscopic skull base surgery. Laryngoscope 125(3):577–581. https://doi.org/10.1002/lary.24989 CrossRefPubMed

67.

Wang J, Bidari S, Inoue K, Yang H, Rhoton A (2010) Extensions of the sphenoid sinus: a new classification. Neurosurgery 66(4):797–816. https://doi.org/10.1227/01.NEU.0000367619.24800.B1 CrossRefPubMed

68.

Wiebracht ND, Zimmer LA (2014) Complex anatomy of the sphenoid sinus: a radiographic study and literature review. J Neurol Surg B Skull Base 75(6):378–382. https://doi.org/10.1055/s-0034-1376195 CrossRefPubMedPubMedCentral

69.

Yonetsu K, Watanabe M, Nakamura T (2000) Age-related expansion and reduction in aeration of the sphenoid sinus: volume assessment by helical CT scanning. AJNR Am J Neuroradiol 21(1):179–182PubMed

Titel: Sphenoid sinuses: pneumatisation and anatomical variants—what the radiologist needs to know and report to avoid intraoperative complications
verfasst von: Michaela Cellina
Daniele Gibelli
Chiara Floridi
Tahereh Toluian
Carlo Valenti Pittino
Carlo Martinenghi
Giancarlo Oliva
Publikationsdatum: 11.05.2020
Verlag: Springer Paris
Erschienen in: Surgical and Radiologic Anatomy / Ausgabe 9/2020
Print ISSN: 0930-1038
Elektronische ISSN: 1279-8517
DOI: https://doi.org/10.1007/s00276-020-02490-y

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Sphenoid sinuses: pneumatisation and anatomical variants—what the radiologist needs to know and report to avoid intraoperative complications