Floreani Stephen R, Nair Salil B, Switajewski Michael C, Wormald Peter-John
Department of Surgery, Otolaryngology, Head and Neck Surgery, University of Adelaide and Flinders University, Adelaide, South Australia.
Laryngoscope. 2006 Jul;116(7):1263-7. doi: 10.1097/01.mlg.0000221967.67003.1d.
The objective of this study was to investigate the radiologic and endoscopic anatomy of the anterior ethmoidal canal (AEC) and feasibility of endoscopic ligation of the anterior ethmoidal artery (AEA).
The authors conducted a prospective analysis of computed tomography (CT) of the paranasal sinuses and endoscopic cadaver dissection.
Twenty-two cadaver heads had CT scans of the paranasal sinuses. The height of the lateral lamella of the cribriform plate was calculated and staged according to the Keros staging system. The presence of a bony mesentery, distance from AEC to the skull base, and dehiscence of the AEC were documented. Forty-four dissections were performed, the AECs identified, and AEA ligation attempted.
The mean height of the lateral lamella was 5.4 mm on the right and 4.7 mm on the left. In all cadaver heads with asymmetry, the right lateral lamella was longer (P<.005). A Keros type 1 pattern was seen in 23%, type 2 in 50%, and type 3 in 27%. Thirty-six percent of AECs were in a bony mesentery. AEC distance from the skull base was greater on the right (P<.009). A longer lateral lamella was correlated with the artery being in a mesentery. Sixteen percent of the AECs were dehiscent. Sixty-six percent of AEAs were unable to be clipped. Twenty percent were clipped effectively, all in a mesentery. In 14%, the AEA was not effectively clipped.
Endoscopic AEA ligation may be possible in some patients. The AEA should be in a mesentery for an effective clip to be placed and be associated with a dehiscence of the AEC. If the lateral lamella is classified as Keros grade 2 or 3, it is likely the AEC will be found in a mesentery.
本研究的目的是调查筛前管（AEC）的放射学和内镜解剖结构以及筛前动脉（AEA）内镜结扎的可行性。
作者对鼻窦计算机断层扫描（CT）和内镜尸体解剖进行了前瞻性分析。
22个尸头进行了鼻窦CT扫描。根据Keros分期系统计算并分期筛板外侧板的高度。记录骨系膜的存在、AEC到颅底的距离以及AEC的裂开情况。进行了44次解剖，识别出AEC，并尝试结扎AEA。
右侧外侧板的平均高度为5.4mm，左侧为4.7mm。在所有不对称的尸头中，右侧外侧板更长（P<0.005）。Keros 1型模式见于23%，2型见于50%，3型见于27%。36%的AEC位于骨系膜中。右侧AEC距颅底的距离更大（P<0.009）。外侧板较长与动脉位于系膜中相关。16%的AEC有裂开。66%的AEA无法夹闭。20%夹闭有效，均在系膜中。14%的AEA夹闭无效。
在一些患者中，内镜下结扎AEA可能可行。AEA应位于系膜中以便有效放置夹子，并且与AEC的裂开相关。如果外侧板分类为Keros 2级或3级，则AEC很可能位于系膜中。
