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. 2019 Mar-Apr;85(2):136-143.
doi: 10.1016/j.bjorl.2017.11.008. Epub 2017 Dec 26.

The anatomic analysis of the vidian canal and the surrounding structures concerning vidian neurectomy using computed tomography scans

Gülay Açar  1 , Aynur Emine Çiçekcibaşı  2 , İbrahim Çukurova  3 , Kemal Emre Özen  4 , Muzaffer Şeker  2 , İbrahim Güler  5
Affiliations

The anatomic analysis of the vidian canal and the surrounding structures concerning vidian neurectomy using computed tomography scans

Gülay Açar et al. Braz J Otorhinolaryngol. 2019 Mar-Apr.

Abstract
in English, Portuguese

Introduction: The type of endoscopic approach chosen for vidian neurectomy can be specified by evaluating the vidian canal and the surrounding sphenoid sinus structures.

Objective: The variations and morphometry of the vidian canal were investigated, focusing on the functional correlations between them which are crucial anatomical landmarks for preoperative planning.

Methods: This study was performed using paranasal multidetector computed tomography images that were obtained with a section thickening of 0.625mm of 250 adults.

Results: The distributions of 500 vidian canal variants were categorized as follows; Type 1, within the sphenoid corpus (55.6%); Type 2, partially protruding into the sphenoid sinus (34.8%); Type 3, within the sphenoid sinus (9.6%). The pneumatization of the pterygoid process is mostly seen in vidian canal Type 2 (72.4%) and Type 3 (95.8%) (p<0.001). The mean distances from the vidian canal to the foramen rotundum and the palatovaginal canal were greater in the vidian canal Type 2 and 3 with the pterygoid process pneumatization (p<0.001). The prevalence of the intrasphenoid septum between the vidian canal and the vomerine crest and lateral attachment which ending on carotid prominence were much higher in vidian canal Type 3 than other types (p<0.001). The mean angle between the posterior end of the middle turbinate and the lateral margin of the anterior opening of the vidian canal was measured as 33.05±7.71°.

Conclusions: Preoperative radiologic analysis of the vidian canal and the surrounding structures will allow surgeons to choose an appropriate endoscopic approach to ensure predictable postoperative outcomes.

Introdução: O tipo de abordagem endoscópica para a neurectomia do vidiano pode ser definido pela avaliação do canal do vidiano e das estruturas adjacentes aos seios esfenoidais.

Objetivo: Investigar as variações e a morfometria do canal vidiano com enfoque nas suas correlações funcionais, pois são parâmetros anatômicos cruciais para o planejamento pré-operatório.

Método: Esse estudo foi realizado utilizando-se imagens de tomografia computadorizada multidetectores dos seios paranasais com espessura de corte de 0,625 mm obtidas de 250 indivíduos adultos.

Resultados: A distribuição das 500 variantes do canal vidiano foi categorizada da seguinte forma: Tipo 1, dentro do corpo ósseo esfenoidal (55,6%); Tipo 2, protrusão parcial no interior do seio esfenoidal (34,8%); Tipo 3, no interior do seio esfenoidal (9,6%). A pneumatização do processo pterigoide foi observada principalmente no canal vidiano Tipo 2 (72,4%) e Tipo 3 (95,8%) (p < 0,001). As distâncias médias do canal vidiano até o forame redondo e o canal palatovaginal foram maiores no canal vidiano do Tipo 2 e 3, com a pneumatização do processo pterigoide (p < 0,001). A presença do septo intraesfenoidal entre o canal vidiano e a crista vomeriana e a extensão lateral, que termina na proeminência da carótida, foi muito maior no canal vidiano Tipo 3 do que nos outros tipos (p < 0,001). A angulação média entre a cauda da concha média e a margem lateral da abertura anterior do canal vidiano foi de 33,05° ± 7,71°.

Conclusões: A análise radiológica pré-operatória do canal do vidiano e das estruturas circunjacentes permitem ao cirurgião escolher uma abordagem endoscópica apropriada e prever resultados pós-operatórios.

Keywords: Análise morfométrica; Canal pterigoideo; Intrasphenoid septum; Morphometric analysis; Neurectomia do pterigoideo; Pneumatização do processo pterigoide; Pterygoid process pneumatization; Septo intraesfenoidal; Vidian canal; Vidian neurectomy.

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Figures

Figure 1
Figure 1
Coronal CT sections showing the vidian canal (thick arrow), palatovaginal canal (thin arrow), foramen rotundum (arrowhead), pterygoid recess pneumatization (star). (A) Bilateral vidian canals inside the sphenoid corpus (VC Type 1), the right vidian canal located lateral to medial pterygoid plate and left located at same line. (B) The vidian canals which partially protruding into the sphenoid sinus (VC Type 2) bilaterally located at same line with the medial pterygoid plate. (C) The vidian canals which totally inside the sphenoid sinus with a stalk (VC Type 3).
Figure 2
Figure 2
(A) Coronal CT section showing the conchal type sphenoid pneumatization pattern (star); (B) Axial CT section showing the intrasphenoid septum which deviated and attached on the carotid prominence (ICAS) (thick arrow).
Figure 3
Figure 3
Morphometric measurements (A) Coronal CT sections showing the distance from the vidian canal to palatovaginal canal (black dotted line) and the foramen rotundum (white dotted line), the septum (thin arrow) between the vidian canal and vomerine crest (thick arrow), the pterygoid process pneumatization (star). (B) Axial CT section showing the angle between the posterior end of the middle turbinate and lateral margin of the anterior opening of the vidian canal, the anterior opening of the vidian canal (thick arrow) and the posterior opening of the vidian canal (thin arrow). (C) Coronal CT sections showing the angle between the posterior end of the middle turbinate and lateral margin of the anterior opening of the vidian canal.
Figure 4
Figure 4
(A) Coronal CT image of 19-year-old woman showing unilateral right foramen rotundum (arrowhead, she had no left foramen rotundum) and the vidian canals (thick arrow); (B) coronal CT image of 68-year-old man showing unilateral left foramen rotundum (arrowhead, he had no right foramen rotundum) and the vidian canals (thick arrow).
See this image and copyright information in PMC

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