Type of Article: Original Research
Year: 2016 | Volume 4 | Issue 1 | Page No. 2015-2020
Date of Publication: 29-02-2016
AN ANATOMO-IMAGISTIC STUDY OF INTERSPHENOIDAL SINUS SEPTUM
T. S. Guga Priya 1, N. Vinay Kumar * 2, Arun T. Guru 3, S. D. NalinaKumari 4.
1 Associate Professor, Department of Anatomy, Chennai Medical College Hospital and Research Centre, Irungalur, Trichy, Tamilnadu, India.
*2 Associate Professor, Department of Anatomy, Government Medical College, East Yakkara, Palakkad, Kerala, India.
3 Assistant Professor, Department of Radiodiagnosis, Chennai Medical College Hospital and Research Centre, Irungalur, Trichy, Tamilnadu, India.
4 Professor and Head , Department of Anatomy, Chennai Medical College Hospital and Research Centre, Irungalur, Trichy, Tamilnadu, India.
Address: Dr. N. Vinay Kumar, Associate Professor, Department of Anatomy, Government Medical College, East Yakkara, Palakkad-678013, Kerala, India.
Introduction: Asymmetrically divided sphenoid sinuses exhibits a variety of variation in the formation of inter sinus septum. Previously reported range of incidence of single midline inter-sphenoid sinus septum is from 18.2% to 95% .Many studies have reported differing incidences of laterally placed septum, accessory septa, multiple septa, transverse septa and no septum in the sphenoid sinuses. Termination of inter-sphenoid septum either into internal carotid canal or into optic canal had also been shown in many studies with possibilities of high risk complications related to such termination of septum. Only limited data is available in Indian ethnicity about the variations in presentation of inter-sphenoid sinus septum compounded by the relative high frequency of occurrence of endoscopic trans sphenoid microsurgeries. Hence, this study was done to observe variations occurring in septum of sphenoid sinuses.
Materials and Methods: A retrospective CT analysis of images obtained from 114 patients diagnosed with sinusitis during a specific study period was done by two independent observers. The age of the patients ranged from 16-60 years of both sexes. Patients with history of prior sinus or sphenoid surgery, facial trauma, obscured sphenoid sinus pathology were excluded.
Results: Single inter sphenoid sinus septum was seen in 83.3% .Out of this Midline, right deviation, left deviation were observed in 11.4%, 33.9% and 21.9% respectively. In 16.7 % images, accessory /multiple septum were noticed. While, absent inter sphenoid septum and transverse septum were noted each in 0.8% of images studied. The termination of inter sinus septum to internal carotid canal occurred in 27.3% and into optic canal in 48% of all images studied.
Conclusion: This study concluded that the variation in presentation of inter-sphenoid septum and its termination at internal carotid artery canal or optic canal need to be pre operatively evaluated by surgeons for considering risk of septal resection during Trans sphenoid endoscopic surgeries.
Key words: Sphenoid sinus, Septum, Inter-sphenoid septum, Trans sphenoid endoscopic.
- Rice DH, Schaefer SD, Anatomy of the Paranasal Sinuses. In: Rice DH, Schaefer SD Endoscopic Paranasal Sinus Surgery. 2004; Lippincott Williams & Wilkins, 3rd edn. 48-50.
- Van Cauwenberge P, Sys L, De Belder T et al. Anatomy and physiology of the nose and the paranasal sinuses. Immunol Allergy Clin North Am. 2004; 24(1):1–17.
- Kronomer KA, Mcalister WH. Sinusitis and its imaging in the paediatric population. Pediatr Radiol. 1997; 27:837-46.
- Sethi DS, Stanley RE, Pillay PK. Endoscopic anatomy of the sphenoid sinus and sella turcica. J Laryngol Otol.1995; 109(10):951–5.
- Hardy J. The transsphenoidal surgical approach to the pituitary. Hosp Pract. 1979; 14(6):81-89.
- Renn WH, Rhoton Jr AL. Microsurgical anatomy of the sellar region. J Neurosurg. 1975; 43:288-98.
- Kinnman, J. Surgical aspects of the anatomy of the sphenoidal sinuses and the sella turcica. J Anat. 1977; 124(Pt 3): 541
- Elwany S, Yacout YM, Talaat M, El-Nahass M, Gunied A, Surgical Anatomy of The Sphenoid Sinus The Journal of Laryngology and Otology 1983; 97:227-41.
- Banna M, Olutola PS. Patterns of pneumatization and septation of the sphenoidal sinus. J Can Assoc Radiol. 1983; 34(4):291-3.
- Ouaknine GE, Hardy J. Microsurgical anatomy of the pituitary gland and the sellar region. 2. The bony structures. Am Surg. 1987; 53(5):291-7.
- Scuderi AJ,Harnsberger HR, Boyer RS. Pneumatization of the paranasal sinuses; normal features of importance to the accurate interpretation of CT scans and MR images. AJR Am J Roentgenol 1993; 160:1101-4.
- Szolar D,Preidler K,Ranner G, et al. The sphenoid sinus during childhood: Establishment of normal developmental standards by MRI. Surg Radiol Anat 1994; 16:193-8.
- Samy Elwany, Ibraheim Elsaeid, Hossam Thabet, Endoscopic anatomy of the sphenoid sinus The Journal of Laryngology and Otology February 1999; 113:122-26.
- Sirikci A, Bayazit YA, Bayram M, Mumbuc S, Gungor K, Kanhkama M. Variations of sphenoid and related structures. Eur Radiol 2000; 10: 844-848.
- Abdullah BJ, Arasaratnam S, Kumar G, Gopala K. The sphenoid sinuses: computed tomography assessment of septation, relationship to the internal carotid arteries, and sidewall thickness in the Malaysian population. J HK Coll Radiol. 2001; 4:185-188.
- Sareen D, Agarwal AK, Kaul JM, Sethi A, Study of sphenoid sinus anatomy in relation to endoscopic surgery, Int J Morphol, 2005, 23(3):261–266.
- Kazkayasi, M., Karadeniz, Y. & Arikan, O.K. Anatomic variations of the sphenoid sinus on computed tomography. Rhinology. 2005; 43(2): 109-14.
- Unal B, Bademci G, bilgili YK, batay F, Avci E. Risky Anatomic variations of sphenoid sinus for surgery. Surg. Radiol.Anat. 2006; 28:195-201.
- Davoodi M, Saki N, Saki G, Rahim F. Anatomical variations of neurovascular structures adjacent sphenoid sinus by using CT scan. Pak J Biol Sci 2008; 12(6):522-5.
- Hamid O, El Fiky L, Hassan O, et al. Anatomic variation of the sphenoid sinus and their impact on trans-sphenoid pituitary surgery. Skull Base 2008;18:9-16
- Idowu OE, Balogun BO, Okoli CA. Dimensions, septation, and pattern of pneumatisation of the sphenoidal sinus. Folia Morphol. 2009; 68(4):228-232.
- Fernandez-Miranda JC, Prevedello DM, Madhok R, Morera V, Barges-Coll J, Reineman K, Snyderman CH, Gardner P, Carrau R, Kassam AB, Sphenoid septations and their relationship with internal carotid arteries: anatomical and radiological study, Laryngoscope, 2009, 119(10):1893–1896
- Jaworek JK, Troc P, Chrzan R, Sztuk S, Urbanik A, Walocha J. Anatomic variations of the septation within the sphenoid sinus on CT scan images -an initial report. Przegl Lek. 2010; 67(4): 279-83.
- Li SL, Wang ZC, Xian JF. Study of variations in adult sphenoid sinus by multislice spiral computed tomography. Zhonghua Yi Xue Za Zhi. 2010; 90(1):2172–2176.
- Zada, G., Agarwalla, P.K., Mukundan, Jr S.,Dunn, I., Golby, A.J. & Laws, Jr E.R. The neurosurgical anatomy of the sphenoid sinus and sellar floor in endoscopic trans sphenoidal surgery: Clinical article. Journal of neurosurgery. 2011; 114(5):1319-1330.
- Fasunla AJ, Ameye SA, AdebolaOS, Ogbole G, Adeleye AO, Adekanmi AJ. Anatomical Variations of the Sphenoid Sinus and Nearby Neurovascular Structures Seen on Computed Tomography of Black Africans. East and Central African journal of surgery.2012; 17(1):57-64.
- Eldan Kapur , Adnan Kapidžić , Amela Kulenović , Lana Sarajlić , Adis Šahinović ,Maida Šahinović .Septation of the Sphenoid Sinus and its Clinical Significance. International Journal of Collaborative Research on Internal Medicine & Public Health. 2012;4 (10):1793-1802
- Tarek H. ELKammash, Moanes M. Enaba Akram M. Awadalla. Variability in sphenoid sinus pneumatization and its impact upon reduction of complications following sellar region surgeries. The Egyptian Journal of Radiology and Nuclear Medicine. 2014; 45: 705–714.
- Manisha S. Chougule, Daksha Dixit .A cross-sectional study of sphenoid sinus through gross and endoscopic dissection in north Karnataka, India. Journal of Clinical and Diagnostic Research. 2014 ;04[cited:2014 Nov 12]: 4 AC01 - AC05
- Afsoun Seddighi, Amir Saied Seddighi, Omid Mellati,ahangir Ghorbani, Nasim Raad, Mohammad Mehdi Soleimani. Sphenoid Sinus: Anatomic Variations and Their Importance in Trans-sphenoid SurgeryInternational Clinical Neuroscience Journal. 2014;Vol 1(1):31-34
- Bilal Battal, Sinan Akay , Bülent Karaman, Salih Hamcan, Veysel Akgün, Sebahattin Sari, Uğur Bozlar, Mustafa Taşar. The relationship between the variations of sphenoid sinus and nasal septum. Gülhane Tıp Derg 2014;56: 232-237
- Lupascu M, Comsa Gh. I, Zainea.V. Anatomical variations of the sphenoid sinus - a study of 200 cases. ARS Medica Tomitana . 2014; 2(77):57-62.
- Dündar R, Kulduk E, Soy FK, Aslan M, K›lavuz AE, Sakarya EU, Yaz›c H, Eren A. Radiological evaluation of septal bone variations in the sphenoid sinus. J Med Updates. 2014; 4(1):6-10.
- Madiha.A.EL Sayed,Alaa. A. raouf. Endoscopic anatomy of the sphenoid Air sinus. Bull.Alex.Fac. Med.2007;43(7).
- Vidya CS, Keshav Raichurkar. Anatomic variation of Sphenoid sinus in Mysore based population: CT scan Study. Int J Anat Res 2015; 3(4):1611-1614. DOI: 10.16965/ IJAR.2015.300
- Justin Poirier, Donald Lee, Neil Duggal, Brian W. Rotenberg. The Intersphenoid Sinus Septum: An Impractical Anatomic Landmark in Transsphenoidal Endoscopic Pituitary Surgery. Skull Base. 2011;21(S 01); A066. DOI: 10.1055/s-2011-1274241
- Filho BC, Pinheiro-Neto CD, Weber R, Voegels RL. Sphenoid sinus symmetry and differences between sexes. Rhinology. 2008; 46(3):195-199.
T. S. Guga Priya, N. Vinay Kumar, Arun T. Guru, S. D. NalinaKumari. AN ANATOMO-IMAGISTIC STUDY OF INTERSPHENOIDAL SINUS SEPTUM. Int J Anat Res 2016;4(1):2015-2020. DOI: 10.16965/ijar.2016.133