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. 2018 Jan-Feb;59(1):7-13.
doi: 10.4103/nmj.NMJ_138_18.

Sphenoid Sinus Pneumatization, Septation, and the Internal Carotid Artery: A Computed Tomography Study

Olusola C Famurewa  1 , Bolanle O Ibitoye  2 , Sanyaolu A Ameye  2 , Christianah M Asaleye  1 , Oluwagbemiga O Ayoola  1 , Olaoluwa S Onigbinde  3
Affiliations

Sphenoid Sinus Pneumatization, Septation, and the Internal Carotid Artery: A Computed Tomography Study

Olusola C Famurewa et al. Niger Med J. 2018 Jan-Feb.

Abstract

Background: The air spaces of the nasal cavity and the sphenoid sinus (SS) constitute a convenient corridor to access lesions of the skull base using the endoscopic endonasal transsphenoidal approach (EETA). Safe EETA depends on the SS and skull base anatomy of the patient. Individual variations exist in the degree and pattern of SS pneumatization. This study aims to examine the variations in SS pneumatization, the inter-sphenoid septum (ISS), and their relationship with the internal carotid artery (ICA) among adult Nigerians.

Materials and methods: We reviewed computerized tomography (CT) images of 320 adult patients that had imaging for various indications. This excluded those with traumatic, inflammatory, or neoplastic process that may alter anatomical landmarks. The images were evaluated for the types of SS pneumatization, number and insertion of ISS, and the protrusion of ICA into the sinus cavity.

Results: Prevalence of SS pneumatization types: 1.9% conchal, 1.2% presellar, 56.6% sellar, and 40.2% postsellar. The lateral extension of SS occurred into the pterygoid in 138 patients (45.1%), greater wing 112 (35%), lesser wing 37 (11.6%), the full lateral type was seen in 97 (30.3%) patients. One ISS occurred in 150 (46.9%) patients, 162 (50.6%) had multiple, and 8 (2.5%) had none. ISS insertion into ICA bony covering occurred in 101 (31.6%) patients, whereas protrusion of ICA into SS cavity occurred in 110 (34.4%) patients.

Conclusion: Variations of the SS, ISS, and ICA anatomy are present among native Africans. Detailed imaging evaluation of each patient is considered for EETA is mandatory.

Keywords: Internal carotid artery; intersphenoid septum; sphenoid sinus; variation.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Sagittal computed tomography image. Conchal: The region below the sella consists of a solid block of bone with no air cavity
Figure 2
Figure 2
Sagittal computed tomography image. Presellar: The air cavity does not penetrate beyond a vertical plane parallel to the anterior sellar wall
Figure 3
Figure 3
Sagittal computed tomography image. Sellar: The sinus is well developed; pneumatization extends beyond the tuberculum sella below the sella
Figure 4
Figure 4
Sagittal computed tomography image. Post-sellar: The air cavity extends into the body of the sphenoid, continues beyond the posterior margin of the dorsum sella into the clivus bone. Pneumatization of the dorsum sella is also present
Figure 5
Figure 5
Coronal computed tomography image. Complete lateral type with extension of sphenoid sinus into greater wing of sphenoid (square), and pterygoid process (triangle) on the right. Ipsilateral extension of sphenoid sinus into the anterior clinoid process (circle) is also present
Figure 6
Figure 6
Axial computed tomography image. Complete intersphenoid septum inserted into the posterior wall of the sphenoid sinus, incomplete ISS inserted into the bony covering of the right internal carotid artery, bilateral internal carotid artery protrusion
Figure 7
Figure 7
(a) Coronal computed tomography image. Bilateral Onodi cells (circles). (b) Sagittal computed tomography image. Onodi cell (circle)
Figure 8
Figure 8
Coronal computed tomography image. Right hemi-sphenoid sinus aplasia: appearing as a solid block of bone (circle). The left hemi-sphenoid sinus is pneumatized
See this image and copyright information in PMC

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