한국인의 내시경 부비동 수술에서 Keros와 Gera 분류 간의 상관관계 검증
Validation of the Correlation between Keros and Gera Classification in Endoscopic Sinus Surgery in Koreans
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background and Objectives: The lateral lamella of cribriform plate is the thinnest part of the skull base (SB), and there is a possibility of perforation during endoscopic sinus surgery (ESS). Keros and Gera classifications are known for predicting the risk of damage to the SB. The Keros classification is divided into three types according to the depth of the olfactory fossa, and the longer the depth of the olfactory fossa, the more vulnerable it is to damage SB. The Gera classification was divided into three types by measuring the slope of the ethmoid roof as an angle, and the smaller the angle, the more vulnerable it is to damage the SB. Therefore, this study attempted to analyze the correlation between the both classifications in Koreans. Materials and Methods: We analyzed 294 adult patients with sinus computed tomography images (588 sides) performed for diagnosis. We measured the lateral lamella length (LLL, distance between the fovea ethmoidalis and the horizontal cribriform plate in the olfactory fossa) and Gera angle (GA, angle between LLCP and lateral extension of horizontal plane passing through cribriform plate), and classified them into each type. Statistical analysis was performed for using the chi-square test, student t test, paired t test, and Pearson's correlation test. Results: There was no gender difference in the LLL (p=0.406). The GA in females (64.0±12.3°) was greater than that in males (61.3±14.0°), showing significant gender difference (p=0.019). The average LLL on the left side (5.92±1.92 mm) was significantly longer than that on the right (5.49±1.79 mm) (p<0.001). The average GA on the left side (63.3±13.1°) was significantly larger than that on the right (61.8±13.5°; p=0.017). The LLL and GA showed a strong positive correlation (r=0.629, p=<0.001). Conclusion: The significant differences of LLL and GA between both sides and a significantly higher GA in female than male patients raises a precaution for rhinology surgeons to more appreciate the inter-personal and gender-differences of the anterior cranial fossa SB anatomy upon performing ESS or SB surgery.
Abstract
Background and Objectives: The lateral lamella of cribriform plate is the thinnest part of the skull base (SB), and there is a possibility of perforation during endoscopic sinus surgery (ESS). Keros and Gera classifications are known for predicting the risk of damage to the SB. The Keros classification is divided into three types according to the depth of the olfactory fossa, and the longer the depth of the olfactory fossa, the more vulnerable it is to damage SB. The Gera classification was divided into three types by measuring the slope of the ethmoid roof as an angle, and the smaller the angle, the more vulnerable it is to damage the SB. Therefore, this study attempted to analyze the correlation between the both classifications in Koreans. Materials and Methods: We analyzed 294 adult patients with sinus computed tomography images (588 sides) performed for diagnosis. We measured the lateral lamella length (LLL, distance between the fovea ethmoidalis and the horizontal cribriform plate in the olfactory fossa) and Gera angle (GA, angle between LLCP and lateral extension of horizontal plane passing through cribriform plate), and classified them into each type. Statistical analysis was performed for using the chi-square test, student t test, paired t test, and Pearson's correlation test. Results: There was no gender difference in the LLL (p=0.406). The GA in females (64.0±12.3°) was greater than that in males (61.3±14.0°), showing significant gender difference (p=0.019). The average LLL on the left side (5.92±1.92 mm) was significantly longer than that on the right (5.49±1.79 mm) (p<0.001). The average GA on the left side (63.3±13.1°) was significantly larger than that on the right (61.8±13.5°; p=0.017). The LLL and GA showed a strong positive correlation (r=0.629, p=<0.001). Conclusion: The significant differences of LLL and GA between both sides and a significantly higher GA in female than male patients raises a precaution for rhinology surgeons to more appreciate the inter-personal and gender-differences of the anterior cranial fossa SB anatomy upon performing ESS or SB surgery.
참고문헌 (26)
- Vaid S, "Normal anatomy and anatomic variants of the paranasal sinuses on computed tomography", Neuroimaging Clin N Am, 25(4), pp.527~548 (2015)
- Ohnishi T, "Lateral lamella of the cribriform plate : an important high-risk area in endoscopic sinus surgery", Ear Nose Throat J, 74(10), pp.688~690 (1995)
- Keros P, "On the practical value of differences in the level of the lamina cribrosa of the ethmoid", Z Laryngol Rhinol Otol, 41, pp.809~813 (1962)
- Gera R, "Lateral lamella of the cribriform plate, a keystone landmark : proposal for a novel classification system", Rhinology, 56(1), pp.65~72 (2018)
- Mahdian M, "CBCT assessment of ethmoid roof variations through Keros, Gera, and TMS classifications", Int J Otolaryngol, 2022(1), pp.3708851~ (2022)
- Abdullah B, "A new radiological classification for the risk assessment of anterior skull base injury in endoscopic sinus surgery", Sci Rep, 10(1), pp.4600~ (2020)
- Koo HB, "Laterality of ethmoid roof in a Korean population", J Rhinol, 28(2), pp.102~105 (2021)
- Son SJ, "A study of skull base according to Gera classification in a Korean population", Korean J Otorhinolaryngol Head Neck Surg, 67(2), pp.87~91 (2023)
- Jacob TG, "Morphology of the olfactory fossa : a new look", J Anat Soc India, 63(1), pp.30~35 (2014)
- Nitinavakarn B, "Anatomical variations of the lateral nasal wall and paranasal sinuses : a CT study for endoscopic sinus surgery(ESS)in Thai patients", J Med Assoc Thai, 88(6), pp.763~768 (2005)
- Anderhuber W, "Configuration of ethmoid roof in children 0–14 years of age", Laryngo Rhino Otologie, 80(9), pp.509~511 (2001)
- Başak S, "Assessment of some important anatomical variations and dangerous areas of the paranasal sinuses by computed tomography in children", Int J Pediatr Otolaryngol, 55(2), pp.81~89 (2000)
- Ali A, "Anterior skull base : high risk areas in endoscopic sinus surgery in chronic rhinosinusitis : a computed tomographic analysis", Indian J Otolaryngol Head Neck Surg, 57(1), pp.5~8 (2005)
- Erdem G, "A radiological anatomic study of the cribriform plate compared with constant structures", Rhinology, 42, pp.225~229 (2004)
- Güler C, "Analysis of ethmoid roof and skull base with coronal section paranasal sinus computed tomography", J Craniofac Surg, 23(5), pp.1460~1464 (2012)
- Preti A, "Horizontal lateral lamella as a risk factor for iatrogenic cerebrospinal fluid leak : clinical retrospective evaluation of 24 cases", Rhinology, 56(4), pp.358~363 (2018)
- Salroo IN, "Computerised tomographic profile of ethmoid roof on basis of keros classification among ethnic Kashmiri’s", Int J Otorhinolaryngol Head Neck Surg, 2(1), pp.1~5 (2016)
- Kaplanoglu H, "An analysis of the anatomic variations of the paranasal sinuses and ethmoid roof using computed tomography", Eurasian J Med, 45(2), pp.115~125 (2013)
- Babu AC, "Olfactory fossa depth : CT analysis of 1200 patients", Indian J Radiol Imaging, 28(04), pp.395~400 (2018)
- Adeel M, "Asymmetry of lateral lamella of the cribriform plate : a software-based analysis of coronal computed tomography and its clinical relevance in endoscopic sinus surgery", Surg Radiol Anat, 35(9), pp.843~847 (2013)
- Samoliński BK, "Changes in nasal cavity dimensions in children and adults by gender and age", Laryngoscope, 117(8), pp.1429~1433 (2007)
- Costa ALF, "Cone beam computed tomography-based anatomical assessment of the olfactory fossa", Int J Dent, 2019(1), pp.4134260~ (2019)
- Trenouth MJ, "Asymmetry of the human skull during fetal growth", Anat Rec, 211(2), pp.205~212 (1985)
- Vig PS, "Asymmetry of the human facial skeleton", Angle Orthod, 45(2), pp.125~129 (1975)
- Poteet PS, "Analysis of the relationship between the location of the anterior ethmoid artery and Keros classification", Otolaryngol Head Neck Surg, 157(2), pp.320~324 (2017)
- Li M, "Reliability of the supraorbital ethmoid cell vs Keros classification in predicting the course of the anterior ethmoid artery", Int Forum Allergy Rhinol, 9(7), pp.821~824 (2019)