Risk Factors for Anterior Skull Base Injury in Endoscopic Sinus Surgery

Seiichiro Makihara; Kensuke Uraguchi; Tomoyuki Naito; Aiko Shimizu; Aya Murai; Takaya Higaki; Yohei Noda; Shin Kariya; Mitsuhiro Okano; Mizuo Ando

doi:10.7759/cureus.49273

Risk Factors for Anterior Skull Base Injury in Endoscopic Sinus Surgery

Cureus. 2023 Nov 23;15(11):e49273. doi: 10.7759/cureus.49273. eCollection 2023 Nov.

Authors

Affiliations

¹ Otolaryngology-Head and Neck Surgery, Okayama University Hospital, Okayama, JPN.
² Otolaryngology-Head and Neck Surgery, Kagawa Rosai Hospital, Marugame, JPN.
³ Otolaryngology-Head and Neck Surgery, Fukuyama City Hospital, Fukuyama, JPN.
⁴ Otolaryngology, Kawasaki Medical School, Kurashiki, JPN.
⁵ Otolaryngology, School of Medicine, International University of Health and Welfare, Narita, JPN.
⁶ Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, JPN.

Abstract

Objectives This retrospective study aimed to investigate the relationships between the Keros classification, the Gera classification, the vertical height of the posterior ethmoid roof (ER), and anterior ethmoidal artery (AEA) types in Japanese patients. Methods We investigated the computed tomography (CT) slices of paranasal sinuses (120 sides) of 60 patients; measured the cribriform plate (CP) depth, lateral lamella CP angle (LLCPA), and vertical height of the lateral ER from the hard palate (LERHP) at the coronal plane of the posterior ethmoidal artery (PEA); and reviewed the AEA types, whether floating or non-floating. Results CP depth was positively correlated with LLCPA (r=0.63; p<0.01) and the height of LERHP (r=0.19; p<0.05). The height of the LERHP in females was significantly lower than that in males. With increased CP depth, floating AEAs became prevalent (p<0.001). Conclusion In females, low height of the posterior ethmoid sinus roof, where cerebrospinal fluid (CSF) leaks occurred while penetrating the basal lamella, often existed; the heights positively correlated with the Keros classification in Japanese patients. The Keros and Gera classifications, AEA type, and posterior ER height do not individually constitute a complete risk assessment but may correlate, preventing major complications, such as CSF leak and orbital hemorrhage.

Keywords: anterior ethmoidal artery; cerebrospinal fluid leak; gera classification; keros classification; posterior ethmoid roof.

Grants and funding

This work was supported by the Japan Society for the Promotion of Science (JSPS) Grants-in-Aid for Scientific Research (KAKENHI) from the Ministry of Education, Culture, Sports, Science and Technology of Japan (grant number: JP19K09869) and the Japanese Foundation for Research and Promotion of Endoscopy (JFE).