Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan.
Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan.
J Clin Neurosci. 2020 Dec;82(Pt B):225-230. doi: 10.1016/j.jocn.2020.11.005. Epub 2020 Nov 25.
Cerebrospinal fluid (CSF) leakage caused by frontal sinus exposure is a serious complication in the basal interhemispheric approach (BIHA). Crista galli pneumatization (CGP) is often observed on preoperative computed tomography (CT) scan. The aim of this study was to classify and describe variations in anatomical measurements of CGP. We examined CT images of 300 patients with brain tumors to assess the morphology and incidence of CGP. Crista galli were classified according to their location relative to the cribriform plate and the presence of pneumatization. The paranasal sinuses were investigated as the origin of CGP. We assessed 24 patients using the BIHA for skull base tumors; these patients were included as clinical cases to assess the range of skeletonization of the crista galli and determine the route of CSF leakage in the other 276 patients. CGP was found in 28/300 CT scans, including upper, middle, and lower type CGPs. The origin of CGPs was the frontal sinus or ethmoid sinus. All CGPs were localized in the anterior half of the crista galli. In the 24 consecutive clinical cases, there were 13 tuberculum sellae meningiomas, 3 craniopharyngiomas, and 8 with other pathologies. The preoperative crista galli height was 12.3 mm and the distance from the top of the skeletonization to the cribriform plate was 5.2 mm. CGP originating from the paranasal sinuses can lead to CSF leakage. In cases where CGP originates from the ethmoid sinus, care should be taken to seal the exposed crista galli intradurally.
脑脊液（CSF）漏是经额下入路（BIHA）中严重的并发症，额窦暴露可导致脑脊液漏。额窦气化（CGP）在术前计算机断层扫描（CT）中经常观察到。本研究旨在对额窦气化的解剖测量进行分类和描述。我们检查了 300 例脑肿瘤患者的 CT 图像，以评估额窦气化的形态和发生率。额嵴根据其相对于筛板的位置和有无气化为标准进行分类。鼻窦被认为是额窦气化的起源。我们评估了 24 例使用 BIHA 治疗颅底肿瘤的患者，这些患者被纳入临床病例以评估额嵴的骨化范围，并确定在其他 276 例患者中 CSF 漏的途径。在 300 例 CT 扫描中发现 28 例 CGP，包括额窦气化的上、中、下类型。CGP 的起源是额窦或筛窦。所有 CGP 均位于额嵴的前半部分。在 24 例连续临床病例中，有 13 例鞍结节脑膜瘤、3 例颅咽管瘤和 8 例其他病变。术前额嵴高度为 12.3mm，从骨化顶部到筛板的距离为 5.2mm。来自副鼻窦的 CGP 可导致 CSF 漏。如果 CGP 来自筛窦，则应注意在硬脑膜内封闭暴露的额嵴。
