European Radiology

, 16:2092 | Cite as

Basilar expansion of the human sphenoidal sinus: an integrated anatomical and computerized tomography study

  • Rainer G. Haetinger
  • João A. C. Navarro
  • Edson A. Liberti
Head and neck

Abstract

Basilar expansion of the sphenoidal sinus (BESS) was studied in order to demonstrate its critical relevance in endoscopic or microscopic endonasal surgical interventions, including access to the sphenoidal sinus itself or in transsphenoidal pituitary approaches. Direct evaluation of anatomical specimens (25 dry skulls and 25 formalin-fixed hemi heads) and the use of computerized tomography (CT) (50 dry skulls and 750 patients) showed a high BESS frequency (69%). The authors considered BESS to be critical when the posterior wall of the clivus was 2-mm thick and found a high incidence of this important anatomical variation (44%). This study also evaluated the relationship between the sinonasal septa, the clivus, and the internal carotid arteries, and a considerable regularity in the location of these structures was seen. The septa were anatomically related to the internal carotid arteries in 55% and to the clivus in 33% of the cases. In conclusion, the high frequency of critical BESS here described is relevant to endoscopic or microscopic endonasal surgical interventions, including access to the sphenoidal sinus itself or in transsphenoidal pituitary approaches.

Keywords

Sphenoidal sinus Basilar expansion Computed tomography Anatomy Clivus 

References

  1. 1.
    Zuckerkandl E (1892) Normale und pathologische Anatomie der Nasenhöhle und ihrer pneumatischen Anhänge, 2nd ed. Wien-Leipzig, W. BraumuellerGoogle Scholar
  2. 2.
    Sieur J, Jacob O (1901) Recherches anatomiques, cliniques et opératoires sur les fosses nasales et lueurs sinus, 1st ed. J. Rueff, Éditeur, ParisGoogle Scholar
  3. 3.
    Cope VZ (1917) The internal structure of the sphenoidal sinus. Jour Anat 51:127–136Google Scholar
  4. 4.
    Congdon ED (1920) The distribution and mode of origin of septa and walls of the sphenoidal sinus. The Anatomical Record 18(2):97–123CrossRefGoogle Scholar
  5. 5.
    Testut L, Jacob O (1909) Traité d’anatomie topographique, 2nd ed. Octave Doin et Fils, Éditeurs, ParisGoogle Scholar
  6. 6.
    Elwany S, Yacout YM, Talaat M et al (1983) Surgical anatomy of the sphenoidal sinus. J Laryngol Otol 97:227–241PubMedGoogle Scholar
  7. 7.
    Catala M (2003) Développement embryonnaire du sphénoïde. J Neuroradiol 30:193–200Google Scholar
  8. 8.
    Fujioka M, Young LW (1978) The sphenoidal sinuses: radiographic patterns of normal development and abnormal findings in infants and children. Radiology 129:133–136PubMedGoogle Scholar
  9. 9.
    Yonetsu K, Watanabe M, Nakamura T (2000) Age related expansion and reduction in aeration of the sphenoidal sinus: volume assessment by helical CT scanning. Am J Neuroradiol 21:179–182PubMedGoogle Scholar
  10. 10.
    Testut L (1911) Traité d’anatomie humaine, 6th edn. Octave Doin et Fils, Éditeurs, ParisGoogle Scholar
  11. 11.
    Skillern RH (1920) The accessory sinuses of the nose, 2nd edn. J.B. Lippincott Company, PhiladelphiaGoogle Scholar
  12. 12.
    Canuyt G, Terracol J (1925) Le sinus sphénoïdal, 1st edn. Masson et Cie, Editeurs, ParisGoogle Scholar
  13. 13.
    Castro Lima O (1944) Seios paranasais e nervo óptico: contribuição ao estudo da neurite óptica retrobulbar rinogênica, 1st edn. Faculty of Medicine of Bahia, Salvador, BAGoogle Scholar
  14. 14.
    Hammer G, Rådberg C (1961) The sphenoidal sinus - an anatomical and roentgenologic study with reference to transsphenoid hypophysectomy. Acta Radiologica 56(6):401–422PubMedCrossRefGoogle Scholar
  15. 15.
    Chiarugi G (1936) Instituzioni di anatomia dell’uomo, 4th ed. Società Editrice Libraria, MilanoGoogle Scholar
  16. 16.
    Navarro JAC (2000) Surgical Anatomy of the Nose, Paranasal Sinuses, and Pterygopalatine Fossa. In: Stamm AC, Draf W (eds) Micro-endoscopic Surgery of the Paranasal Sinuses and the Skull Base. Springer, Berlin Heidelberg New YorkGoogle Scholar
  17. 17.
    Haetinger RG (2000) Imaging of the Nose and Paranasal Sinuses. In: Stamm AC, Draf W (eds) Micro-endoscopic Surgery of the Paranasal Sinuses and the Skull Base. Springer, Berlin Heidelberg New YorkGoogle Scholar
  18. 18.
    Heermann H (1958) Endonasal surgery with the use of the binocular Zeiss operating microscope. Arch Klin Exp Ohren Nasen Kehlkopfheilk 171:295–297CrossRefGoogle Scholar
  19. 19.
    Messerklinger W (1978) Endoscopy of the Nose. Urban & Schwarzenberg, Baltimore-MunichGoogle Scholar
  20. 20.
    Navarro JAC (2001) The Nasal Cavity and Paranasal Sinuses - Surgical Anatomy, 1st edn. Springer, Verlag Berlin Heidelberg New YorkGoogle Scholar
  21. 21.
    Stamm AC, Pignatari S, Sebusiani BB, Galati MC, Mitsuda S, Haetinger RG (2002) Image-Guided Endoscopic Sinus and Skull Base Surgery. (Cirurgia Endoscópica Nasossinusal e da Base do Crânio Guiada por Computador) Revista Brasileira de Otorrinolaringologia 68:502–509Google Scholar
  22. 22.
    Stamm AC, Pignatari SSN (2005) Transnasal Endoscopic-Assisted Surgery of the Skull Base. In: Cummings C, Flint PN, Harker LA (eds) Otolaryngology and Head and Neck Surgery, Vol. IV, Elsevier/MosbyGoogle Scholar
  23. 23.
    Ferrier J-C, Klossek J-M (2003) Les mucocèles sphénoïdales. J Neuroradiol 30:219–223Google Scholar
  24. 24.
    Rothman SLG, Kier EL, Allen WE III (1976) The radiology of transsphenoidal hypophysectomy: a review of 100 cases. Am J Roentengenol 127(4):601–606Google Scholar
  25. 25.
    Katzenmeyer K, Bailey BJ (2000) Approaches to the Sphenoid. Ear Nose Throat J 70(7):438–440Google Scholar
  26. 26.
    Lang J (1989) Clinical anatomy of the nose, nasal cavity and paranasal sinuses. 1st edn. Thieme Medical Publishers, New YorkGoogle Scholar
  27. 27.
    Van Alyéa OE (1941) Sphenoidal sinus: anatomic study, with consideration of the clinical significance of the structural characteristics if the sphenoidal sinus. Arch Otolaryngology 2(8):225–253Google Scholar
  28. 28.
    Novosellac M, Pecina M, Nemanic D (1966) Recesus occipitalis sinus sphenoidalis. Rad Med Fak Zagreb 14:211–218Google Scholar
  29. 29.
    Rhoton AL, Hardy DG, Chambers SM (1979) Microsurgical anatomy and dissection of the sphenoid bone, cavernous sinus and sellar region. Surg Neurol 12:63–104PubMedGoogle Scholar
  30. 30.
    Sorimashi T, Kamada K, Ozawa T et al (2001) Basilar artery vasculitis secondary to sphenoidal sinusitis - case report. Neurol Med Chir (Tokyo) 41:454–457CrossRefGoogle Scholar
  31. 31.
    Jenkins HA, Calcaterra TC (1977) Spontaneous cerebrospinal rhinorrhea from the sphenoidal sinus. Trans Am Acad Ophtalmol Otolaryngol 84(5):916–918Google Scholar
  32. 32.
    Coiteiro D, Távora L, Antunes JL (1995) Spontaneous cerebrospinal fluid fistula through the clivus: report of two cases. Neurosurgery 37(4):826–828PubMedCrossRefGoogle Scholar
  33. 33.
    Stamm AC, Draf W (2000) Micro-endoscopic surgery of the paranasal sinuses and the skull base, 1st edn. Springer, Berlin Heidelberg New YorkGoogle Scholar
  34. 34.
    Jho HD, Carrau RL, McLaughlin ML, Somaza SC (1997) Endoscopic transsphenoidal ressection of a large chordoma in the posterior fossa. Acta Neurochir 139:343–348CrossRefGoogle Scholar
  35. 35.
    Rothman SLG, Kier EL, Kirchner JE et al (1975) Preoperative laminographic evaluation of the sphenoidal sinus for transsphenoidal surgery. Laryngoscope 85:1986–1988PubMedCrossRefGoogle Scholar
  36. 36.
    Mutlu C, Unlu HH, Goktan C et al (2001) Radiologic anatomy of the sphenoidal sinus for intranasal surgery. Rhinology 39(3):128–132PubMedGoogle Scholar
  37. 37.
    Peele JC (1957) Unusual anatomical variations of the sphenoidal sinuses. Laryngoscope 67:208–237PubMedGoogle Scholar
  38. 38.
    Bonneville JF, Bonneville F, Cattin F (2005) Magnetic resonance imaging of pituitary adenomas. Eur Radiol 15:543–548PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Rainer G. Haetinger
    • 1
    • 3
  • João A. C. Navarro
    • 2
  • Edson A. Liberti
    • 3
  1. 1.Med Imagem Radiological DepartmentHospital Beneficência Portuguesa of São PauloSão PauloBrazil
  2. 2.Laboratory of Anatomy, School of Dentistry of BauruUniversity of São PauloSão PauloBrazil
  3. 3.Departamento de Anatomia do Instituto de Ciências Biomédicas da Universidade de São PauloSão PauloBrazil

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