Fernandez-Miranda Juan C, Prevedello Daniel M, Madhok Ricky, Morera Victor, Barges-Coll Juan, Reineman Katharine, Snyderman Carl H, Gardner Paul, Carrau Ricardo, Kassam Amin B
Department of Neurosurgery, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15213, U.S.A.
Laryngoscope. 2009 Oct;119(10):1893-6. doi: 10.1002/lary.20623.
OBJECTIVES/HYPOTHESIS: We sought to investigate the anatomical relation of the intrasphenoid septations to the internal carotid artery (ICA).
Twenty-seven preoperative high-resolution computed tomography angiographic (CTA) scans with 1 mm of separation acquisition were examined. In addition, an endoscopic endonasal approach and high-resolution computed tomography were done on 27 fresh-frozen cadaveric heads. The number of intrasphenoid septa and their relation to the ICAs were analyzed endoscopically and radiologically. Complete and incomplete septations were included in the analysis. A total of 54 sphenoid sinuses were studied.
Out of 27 sphenoid sinuses radiologically studied from real patients, 23 (85%) and 11 (41%) had at least one or two septa, respectively, touching one of the ICA. Out of 27 sphenoid sinuses endoscopically examined from cadavers (excluding one conchal type), 24 (89%) had at least one septation inserted in the ICAs. Two or more septations were inserted in the carotid prominence in 48% of sphenoid sinuses. The radiological examination of the anatomical specimens revealed similar results, with discrepancy in just one case (1/27) where it did not identify an incomplete septation inserting at ICA. No significant differences were found between the groups. From a total of 54 sphenoid sinuses studied, 47 (87%) had at least one septum related to the ICA, and only 13% presented a typical isolated midline septation.
As demonstrated both radiographically and endoscopically, most intrasphenoidal septa insert at the parasellar or paraclival carotid prominence. As such, extreme care should be taken when identifying and removing these septations intraoperatively.
目的/假设：我们试图研究蝶窦内分隔与颈内动脉（ICA）的解剖关系。
对27例术前层厚为1mm的高分辨率计算机断层血管造影（CTA）扫描进行了检查。此外，对27个新鲜冷冻尸体头部进行了鼻内镜下鼻内入路和高分辨率计算机断层扫描。在内镜和影像学上分析蝶窦内分隔的数量及其与颈内动脉的关系。分析包括完全分隔和不完全分隔。共研究了54个蝶窦。
在对实际患者进行的27个蝶窦的影像学研究中，分别有23个（85%）和11个（41%）至少有一个或两个分隔接触到颈内动脉之一。在对尸体进行鼻内镜检查的27个蝶窦（不包括一个鼻甲类型）中，24个（89%）至少有一个分隔插入颈内动脉。48%的蝶窦中有两个或更多分隔插入颈动脉隆起处。对解剖标本的影像学检查显示了相似的结果，仅在1例（1/27）中存在差异，即未识别出插入颈内动脉的不完全分隔。两组之间未发现显著差异。在总共研究的54个蝶窦中，47个（87%）至少有一个与颈内动脉相关的分隔，只有13%呈现典型的孤立中线分隔。
如影像学和内镜检查所示，大多数蝶窦内分隔插入鞍旁或斜坡旁颈动脉隆起处。因此，术中识别和切除这些分隔时应格外小心。
