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Título

Revisiting the Ethmoid Roof and Anterior Ethmoidal Arteries - Danger Areas in Functional Endoscopic Sinus Surgery (FESS)

Introdução e objetivo(s)

The functional endoscopic sinus surgery (FESS) is a common surgical procedure performed worldwide, it is known to be a minimal invasive method. There are a lot of indications for FESS such as chronic rhinosinusitis, mucocele, choanal atresia, nasal polyposis, sellar and parasellar tumors, optic nerve decompression, the treatment of epistaxis and epiphora due to low lacrimal tract obstruction, and other disorders. A CT or, in some cases, MRI is necessary before the procedure, general radiologists and head and neck radiologists must elaborate the report with attention to describe anatomic features such as ethmoidal arteries course, the depth of olfactory fossa, in case of an expansive lesion, it is critical to report its limits and relations to anatomic repairs. Our study aims to review the anatomy of the ethmoid roof, highlighting the danger areas of possible post/intra-operative complications due to its unique anatomy.

Método(s)

This study consists in a pictorial essay based in a serial of selected anonymized cases from our database imaging system that were collected and analyzed, in order to review the anatomy of the ethmoid roof and its importance to the surgeons, during the planning of the procedure. Were selected CT and MRI sequences that illustrates the course of the ethmoidal arteries, the depth of olfactory fossa, including the Keros classification, the height and lateral inclination of the lateral lamella of the cribriform plate, anatomic repairs and other features.

Discussão

The minacious knowledge of the ethmoid roof anatomy is crucial on trying to avoid several procedure complications. One of the most common complications of FESS is the injury to the anterior ethmoidal artery (AEA) causing bleeding, elevating the intra-orbital pressure, which increases the risk of optic nerve damage. AEA injuries can result in massive hemorrhage or rhinorrhea secondary to cerebrospinal fluid leak.

Conclusões

General radiologists and head and neck radiologists must elaborate the report carefully, describing the anatomy of the ethmoid roof, such as the knowledge of the exact location and course of the AEA in order to minimize intracranial and orbital complications post FESS.

Palavras Chave

FESS - Anterior Ethmoidal Arteries- Ethmoid Roof Anatomy

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