Author(s)
Mingsi Li, MD
Daniel D. Sharbel, MD
Brandon White
Sandra Tadros
Stilianos E. Kountakis, MD, FARS
Affiliation(s)
Medical College of Georgia
Abstract:
Objective: We previously demonstrated that the supraorbital ethmoid cell (SOEC) is a reliable landmark for identifying the anterior ethmoidal artery (AEA). Recent data have suggested that Keros classification is also a dependable predictor. We aim to characterize the location of the AEA and its relation to the skull base in patients with and without SOEC through utilizing the Keros classification.Study Design: Retrospective radiographic studySubjects and Methods: Computed tomography (CT) scans of 76 patients (40 with SOEC, 36 without) were evaluated. Distance of AEA from skull base and prevalence of AEA outside of the skull base were measured on each side and compared between groups using the two sample t-test and X2 test, respectively. Subgroup analysis was carried out based on the Keros classification. Results: Mean distance of AEA from the skull base was 1.321.5mm in patients with SOEC and 0.471.08mm in those without (p<0.001). Prevalence of AEA outside of the skull base was 55.4% in those with SOEC and 18.1% in those without (p<0.001). Comparing patients with SOEC to those without, AEA was found below the skull base in 30% vs. 0% of cases with Keros class I (p=0.45), 58% vs. 14.5% with Keros class II (p<0.001), and 60% vs. 50% with Keros class III (p=0.72). Conclusion: Presence of SOEC is associated with higher prevalence of AEA course below the level of the skull base in all Keros classes, thus placing the artery at greater risk for injury. Careful surgical planning is needed to avoid potential orbital complications.