Explore the vast range of titles available.

The sphenoid sinus (SS) is one of the four paired paranasal sinuses (PNSs) within the sphenoid bone body. Isolated pathologies of sphenoid sinus are uncommon. The patient may have various presentations like headache, nasal discharge, post nasal drip, or non-specific symptoms. Although rare, potential complications of sphenoidal sinusitis can range from mucocele to skull base or cavernous sinus involvement, or cranial neuropathy. Primary tumors are rare and adjoining tumors secondarily invading the sphenoid sinus is seen. Multidetector computed tomography (CT) scan and magnetic resonance imaging (MRI) are the primary imaging modalities used to diagnose various forms of sphenoid sinus lesions and complications. We have compiled anatomic variants and various pathologies affecting sphenoid sinus lesions in this article.

Objective The most common surgical technique for the management of pituitary adenomas is the endoscopic endonasal transsphenoidal approach (EEA). preoperative neuroimaging along with detecting surgical landmarks of the sphenoid sinus during surgery is important for making a successful operation. Method This study includes 1009 patients with pituitary adenomas who underwent EEA between 2013 and 2020. We evaluated the anatomical features of the sphenoid sinus through a panel of items obtained from imaging and intra-operative findings. Results Our result includes 57.38% nonfunctional, 8.42% cushing, 12.39% prolactinoma, and 21.8% acromegaly patients who had undergone endoscopic endonasal transsphenoidal surgery. The mean age of the patients was 45 with a male to female ratio of 1.2:1. Sellar sphenoid type was the most common (91.8%) with only 12% symmetrical inter sphenoid septa, Internal carotid artery dehiscence was found in 1.7% of the cases. Apoplexy was present in 6.3% of patients, which was found more prevalent in nonfunctional adenomas (9.67%, Odds ratio: 4.85, 95% CI 2.24–11.79) and further investigation revealed a significant association between apoplexy and sphenoid mucosal edema and hemorrhage (Odds ratio: 43.0, 95% CI 22.50–84.26), and between apoplexy and cystic lesions (OR = 4.14, 95% CI 1.87–8.45, P -value < 0.0001). Acromegaly is associated with the increased number of lateral recces (Odds ratio: 11.41, 95% CI 7.54–17.52), septation of the sphenoid sinus (Marginal mean: 3.92, 95% CI 3.69–4.14), edematous sinonasal mucosa (Odds ratio: 6.7; 95% CI 4.46–10.08), and higher bony (OR: 4.81, 95% CI 2.60–8.97, P -value < 0.001) and cavernous (OR: 1.7, 95% CI 1.13–2.46, P -value < 0.01) invasion. Conclusion The present study provides anatomical data about the sphenoid sinus and its adjacent vital structures with adenomal specific changes that are necessary to prevent complications during endoscopic advanced transsphenoidal surgery.

Human identification in complex cases, such as charred skeletal remains and advanced decomposition, requires reliable methods to associate the identity of a missing person with an unidentified body. Among the different types of human identification, radiological methods are effective as they generally allow qualitative and quantitative analysis of anatomical, pathological, and therapeutic peculiarities, whose combination of information forms a unique set of characteristics that can lead to a positive identification. In this context, the present study aims to evaluate the distinctiveness of the sphenoid sinuses, and to classify and identify their morphological patterns in the studied population, with potential application for human identification. This retrospective observational study analyzed 91 cone beam computed tomography (CBCT) scans of Brazilian individuals (34 males; 57 females) over the age of 25 years. A qualitative analysis was performed focusing on the sphenoid sinuses' morphological pattern, as well as their presence, number, and position in sagittal and axial CBCT slices. The sphenoid sinuses were present in 100 % of cases, 48.3 % had one septum, 30.7 % had two septa, and 20.8 % had three intersphenoidal septa. Septa type 3 (in the midline) were the most common (42.9 %; n = 39), while type 4 (slightly left to the midline) were the least frequent (3.3 %; n = 3). In the sagittal section analysis, post-sellar type (IVa) septa were the most frequent (50.5 %; n = 46), while the pre-sellar type septa were the least frequent (14.3 %; n = 13). The turbinate pattern (type I) was not detected in this study. From an anatomical point of view, great morphological and dimensional variability were found between the sinuses. It was possible to observe qualitative and quantitative morphological differences that allow the individualization of the sphenoid sinus, which can support human identification. •Sphenoid sinus was present in 100 % of CBCT scans analyzed.•Great morphological variability supports forensic identification.•Most common axial septum position: type 3 (midline insertion).•Post-sellar (IVa) type was most frequent in sagittal sections.•CBCT is a reliable tool for identifying anatomical uniqueness.

PurposeTo measure the volume of the sphenoid and ethmoid sinuses and to analyse the asymmetry index values by age/gender.MethodsThree-dimensional (3D) Computed Tomography (CT) images of 150 individuals (75 females, 75 males) of both sexes between the ages of 18–75 were included in our study. Sphenoid and ethmoid sinus volumes were measured using the 3D Slicer software package on these images, and the asymmetry index was calculated.ResultsIn our study, mean sphenoid sinus volume (female right: 4264.4 mm3, left: 3787.1 mm3; male right: 5201.1 mm3, left: 4818.2 mm3) and ethmoid sinus volume (female right: 3365.1 mm3, left: 3321.2 mm3; male right: 3440.9 mm3, left: 3459.5 mm3) were measured in males and females. Left sphenoid sinus values of males were statistically higher than females (p = 0.036). No statistically significant relationship existed between age, sinus volumes, and asymmetry index (p > 0.05). A statistically weak positive correlation existed between males’ left sphenoid and ethmoid sinus volume (rho = 0.288; p = 0.012). There was no statistical relationship between asymmetry index in the whole group (p > 0.05). A statistically weak negative correlation was found between sphenoid and ethmoid sinus asymmetry index in males (rho=-0.352; p = 0.002). There was no statistical relationship between asymmetry index in females (p > 0.05).ConclusionKnowing paranasal sinus morphology, morphometry, and asymmetry index value will be significant for preoperative and postoperative periods.

Background The standard endoscopic endonasal approach gives access to the median sphenoid sinus, but not to its lateral part. We propose an endoscopic technique for lesions in the lateral sphenoid sinus. Method Based on our experience with 28 patients, we have developed a less invasive approach to the lateral recess of the sphenoid sinus, limiting the opening of the maxillary sinus while avoiding resection of the inferior turbinate and ethmoidal cells. The technique is described. Conclusion The proposed endoscopic approach is reliable and safe to treat CSF leak or tumours located within the lateral recess of the sphenoid sinus.

Many studies revealed that the sphenoid sinus pneumatization (SSP) affects the protrusion/dehiscence of adjacent structures including optic canal (OC), foramen rotundum (FR), vidian canal (VC), and carotid canal (CC). Knowledge of this relationship bears vital importance to identify the safest surgical route during transsphenoidal procedures. Therefore, we aimed to determine the individualized prevalence of the protrusion/dehiscence of adjacent structures based on sagittal and coronal SSP (SSSP and CSSP) patterns. Computed tomography images of 300 patients were analysed to identify the SSSP and CSSP types, and the protrusion/dehiscence of adjacent structures was determined. The relationship between the variables was examined using statistical analysis in terms of age, gender, and laterality. The most prevalent SSSP type was postsellar (62.7%), followed by sellar (30%), presellar (6.6%), and conchal (0.7%). In 71.3% of patients, five types of CSSP were observed, with 23.6% and 21.7% exhibiting Type IV and V, respectively. Our results indicated that postsellar type, Type IV and V CSSP associated with the highest likelihood of protrusion/dehiscence of OC, FR, VC, and CC. Furthermore, no significant correlation was observed between these qualitative variables and gender, with the exception of the VC dehiscence, the protrusion of OC and CC. No notable differences were identified with respect to laterality. Also, the probability of having postsellar type, Type IV and V CSSP, as well as the protrusion of OC, VC, and CC, decreased with increasing age. Further detailed analysis of this association is required to predict the size of the surgical window and to prevent neurovascular injury.

BackgroundIn human anatomy, there are well-known the foramina of the greater sphenoidal wing, the foramen rotundum, the foramen ovale, the foramen spinosum, as well as the inconstant sphenoidal emissary foramen of Vesalius and the foramen of Arnold. Different canals are found in several species of rodents, such as the alisphenoid and sphenopterygoid (SPC) canals.MethodIt was re-explored an archived computed tomography angiogram of a 60 y.o. female case.ResultsBilateral superior recesses of the pterygoid fossae (SRPF) and a right SPC were found. The SRPF on each side penetrated the non-lamellar pterygoid root and superiorly reached the sphenoidal sinus wall. Upper fibres of medial pterygoid muscles were inserted into each SRPF. An unexpected SPC was found on the right side. It opened superiorly on the lateral side of the foramen rotundum and inferiorly at a pterygoid foramen in the superior end of the posterior margin of the lateral pterygoid plate. A sphenoidal emissary vein traversed that SPC to drain into the pterygoid plexus.ConclusionThe SRPF and SPC could also be found in humans. As the sphenoidal emissary veins are surgically relevant, they should not be further regarded as exclusively crossing the foramen of Vesalius but also the SPC.

Purpose Detailed assessment of the extrasinusal pneumatization of the superior and middle turbinate (SCB, MCB), olfactory fossa (OFP), and nasal septum (NSP) in coronal and sagittal sphenoid sinus (SS) pneumatization types provides a precise understanding of the surgical corridors used for skull base surgery. We aimed to analyze the relationships among these variations using computed tomography (CT) images. Methods CT images of 153 patients were retrospectively analyzed for all types of sinonasal pneumatizations and volumes of SCB and sphenoid sinus, together with the prevalence of mucosal thickening of the sphenoid sinus (MTSS). Results The prevalences of cellular, extensive, and complete SCB were 28.6%, 21.1%, and 23.5% in prepterygoid; 38.1%, 42.1%, and 35.3% in prerotundum; and 33.3%, 36.8%, and 41.2% in postrotundum CSSP types, respectively. The frequencies of lamellar, bulbous, and extensive MCB were 29%, 14.3%, and 33.3% in pterygoid, 38.7%, 57.1%, and 25.9% in prerotundum, 32.3%, 8%, and 40.8% in postrotundum CSSP types, respectively. SCB and MCB were observed unilaterally at 24.8% and 30% and bilaterally at 12.8% and 32.7%, respectively. OFP, NSP, and MTSS were detected at 24.2%, 31.4%, and 27.5%, respectively. Increased age was significantly associated with a lower probability of pneumatization in SS and MCB. Conclusions The data obtained showed that the degree of SS pneumatization significantly affected the frequencies of the SCB, MCB, OFP, NSP, and MTSS. Also, the SCB volume is significantly related to the CSSP types. Preoperative CT evaluation is crucial for surgeons to be aware of these variations and to avoid iatrogenic injury.

PurposeSphenoid 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.MethodsA 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”.ResultsWe 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 septationsConclusionThe 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.

Purpose Endoscopic pituitary surgery entails navigating through the nasal cavity and sphenoid sinus to access the sella using an endoscope. This procedure is intricate due to the proximity of crucial anatomical structures (e.g. carotid arteries and optic nerves) to pituitary tumours, and any unintended damage can lead to severe complications including blindness and death. Intraoperative guidance during this surgery could support improved localization of the critical structures leading to reducing the risk of complications. Methods A deep learning network PitSurgRT is proposed for real-time localization of critical structures in endoscopic pituitary surgery. The network uses high-resolution net (HRNet) as a backbone with a multi-head for jointly localizing critical anatomical structures while segmenting larger structures simultaneously. Moreover, the trained model is optimized and accelerated by using TensorRT. Finally, the model predictions are shown to neurosurgeons, to test their guidance capabilities. Results Compared with the state-of-the-art method, our model significantly reduces the mean error in landmark detection of the critical structures from 138.76 to 54.40 pixels in a 1280 × 720-pixel image. Furthermore, the semantic segmentation of the most critical structure, sella, is improved by 4.39% IoU. The inference speed of the accelerated model achieves 298 frames per second with floating-point-16 precision. In the study of 15 neurosurgeons, 88.67% of predictions are considered accurate enough for real-time guidance. Conclusion The results from the quantitative evaluation, real-time acceleration, and neurosurgeon study demonstrate the proposed method is highly promising in providing real-time intraoperative guidance of the critical anatomical structures in endoscopic pituitary surgery.