In Vivo Computed Tomography Direct Volume Rendering of the Anterior Ethmoidal Artery: A Descriptive Anatomical Study

Cascio, Filippo; Cacciola, Alberto; Portaro, Simona; Basile, Gianpaolo Antonio; Rizzo, Giuseppina; Felippu, Andrè Wady Debes; Felippu, Alexandre Wady Debes; Bruschetta, Antongiulio; Anfuso, Carmelo; Cascio, Felice; Milardi, Demetrio; Bramanti, Alessia

doi:10.1055/s-0039-1698776

Filippo Cascio

Department of Otorhinolaryngology, Papardo Piemonte Reunited Hospitals, Messina, Sicilia, Italy

Alberto Cacciola

Department of Biomedical, Odontoiatric, Morphological and Functional Imaging Sciences, Università degli Studi di Messina, Messina, Italy

Simona Portaro

Scientiﬁc Institute for Research, Hospitalization and Health Care Centro Neurolesi Bonino Pulejo, Messina, Italy

Gianpaolo Antonio Basile

Department of Biomedical, Odontoiatric, Morphological and Functional Imaging Sciences, Università degli Studi di Messina, Messina, Italy

Giuseppina Rizzo

Department of Biomedical, Odontoiatric, Morphological and Functional Imaging Sciences, Università degli Studi di Messina, Messina, Italy

Andrè Wady Debes Felippu

Department of Otorhinolaryngology, Instituto Felippu, São Paulo, Brazil

Alexandre Wady Debes Felippu

Department of Otorhinolaryngology, Instituto Felippu, São Paulo, Brazil

Antongiulio Bruschetta

Department of Biomedical, Odontoiatric, Morphological and Functional Imaging Sciences, Università degli Studi di Messina, Messina, Italy

Carmelo Anfuso

Scientiﬁc Institute for Research, Hospitalization and Health Care Centro Neurolesi Bonino Pulejo, Messina, Italy

Felice Cascio

Department of Otorhinolaryngology, Papardo Piemonte Reunited Hospitals, Messina, Sicilia, Italy

Demetrio Milardi

Department of Biomedical, Odontoiatric, Morphological and Functional Imaging Sciences, Università degli Studi di Messina, Messina, Italy

Scientiﬁc Institute for Research, Hospitalization and Health Care Centro Neurolesi Bonino Pulejo, Messina, Italy

http://orcid.org/0000-0001-7311-2757

Alessia Bramanti

Scientiﬁc Institute for Research, Hospitalization and Health Care Centro Neurolesi Bonino Pulejo, Messina, Italy

Address for correspondence Prof. Demetrio Milardi, Department of Biomedical, Dental Sciences and Morphological and Functional Images, Univeristy of Messina, Messina, Italy (e-mail: dmilardi@unime.it).

Conﬂicts of Interest

The authors report that there are no conﬂicts of interest.

	Leftmean ± SD	Rightmean ± SD	pMann-Whitney U test
Anterior ethmoidal artery length	4.75 ± 2.26	5.13 ± 2.29	0.73
Distance from the head of the middle concha	24.35 ± 4.80	25.55 ± 3.95	0.60
Distance from the skull base	2.64 ± 2.54	2.51 ± 2.54	0.76
Distance from the frontal beak	13.06 ± 2.33	12.94 ± 2.73	0.95

	Femalemean ± SD	Malemean ± SD	pMann-Whitney U test
Anterior ethmoidal artery length	4.30 ± 2.42	5.75 ± 1.75	0.10
Distance from the head of the middle concha	24 ± 2.99	26.15 ± 5.54	0.45
Distance from the skull base	2.35 ± 2.60	2.86 ± 2.44	0.62
Distance from the frontal beak	13.54 ± 2.46	12.33 ± 2.45	0.37

Authors	Year	Patients	Controls	Techniques	Results
Yenigun et al	2016	184 CT scans, excluding patients with nasal polyposis, sinus anomalies, previous sinus surgery.		CT scans	Positive correlation between the AEC, the superior–inferior depth of the lateral lamella of the cribriform plate LLCP, and the anterior–posterior length.
Wong et al	2014	1 Waardenburg syndrome and chronic rhinosinusitis	–	CT scan	The AEA was not identified on preoperative CT. Intraoperatively, the AEA was found to be anterior to the bulla ethmoidalis, within the frontal recess, and was inadvertently injured.
Ding et al	2012	32 (30 intracranial aneurisms, 2 meningiomas)	–	3D spin DSA; 320-slice CTA	The entire course of the AEA was seen in 100% (32) of the cases with 3D spine DSA and in 29 of 32 cases (90.1%) with 320-slice CTA, with no significant difference.
Monjas-Cánovas et al	2011	–	20 cadavers	CT scan; MIP	AEA identified in 95% (38/40) of the scans. Mean length of the anterior ethmoidal canal: 8.43 ± 0.74 mm. The angle performed into the skull base was 37.3 ± 5.48 degrees. Topographical location: between the second and third lamella in 90% of the cases (36/40).
Joshi et al	2010	–	50	CT scan	AEA identified in 97% of the scans. Mean distance between artery and skull base: 1.5 mm in absence of the supraorbital cell; 4.86 mm in the presence of the supraorbital cell.
Yang et al	2009	–	15 randomly selected adultcadavers	Dissection	Average diameter of the AEA: 0.80 ± 0.24 mm. Topographical location: between the second and third lamella in 87.5% of the cases; over the roof of the frontal recess cells in 10.7%; over the roof of the posterior ethmoid sinus in 3.6%. The angle formed by the long axis of the artery and the lamina papyracea was 60.5 ± 16.4 degrees.
Souza et al	2009	198 CT scans of patients excluding: patients aged below 12 years, a history of surgery or trauma in the paranasal sinuses or the skull base, congenital anomalies of the face, paranasal sinus malignancies, osteofibrous lesions, sinus diseases.	–	CT scan	AEC identified in 41% of the scans. Anterior ethmoidal sulcus identified in 98% of the scans; anterior ethmoidal foramen identified in 100% of scans.
Han et al	2008	–	24 cadaver heads	Dissection	Mean distance from the axilla: 17.5 mm. Mean distance from the posterior ethmoid artery: 14.9 mm Topographical location: anterior to 31%, at 36%, or immediately posterior to 33% the superior attachment of the basal lamella.
McDonald et al	2008		50	CT scan	Anterior ethmoidal foramen identified in 95% of the cases bilaterally and in the remaining 5% unilaterally. AEA identified in 33% of the scans.
Riehm et al	2008	–	9 cadavers	Dissection, CT scans	Correlation between CT and surgical findings allowed identification of 2 criteria predictive of AEA origin: 1 presence of an ethmoid bulla above the AE C2 AEC located below the ethmoid roof, anterior to the bulla.
Pandolfo et al	2007	20 18 subarachnoid hemorrhage, 2 meningiomas	78 (25 chronic sinusitis, 40 massive poliposis, 13 cases of single polyp	Dual volume angiography and MDCT patients; MDCT controls	On patients, the entire course of the AEA was identified by means of DVA angiography: AEA behind the frontal recess (18/20); AEA near to the posterior wall of frontal recess 2/20. On controls, MDCT only (110/156) AEAs were identified only indirectly; 46 out of 156 were shown in their entirety.
Lannoy-Penisson et al	2007		9 heads	Dissection, CT scan	The arteries were identifiable on CT scans. Topographical location: arteries were included in the roof of the ethmoid in 8 cases; prominent under the roof in 3 cases; distant from the roof in 7 cases, in association with pneumatization of the floor of the orbit.
Erdogmus et al	2006	–	19 adult cadavers	Dissection	The AEA was observed in all specimens except for one case. Average diameter: 92 +/− 0.2 mm on the right and 0.88 +/− 0.15 mm on the left. Four variations of its course were differentiated and described.
Floreani et al	2006	–	22 cadaver heads	CT scan	AEA unable to be clipped in 66% of the cases; clipped effectively, all in a mesentery in 20% of cases; not effectively clipped in 14%.
Araujo Filho et al	2006	–	25 cadavers with no past nasosinusal injury/surgery and altered anatomy	Dissection	Average intranasal length of the AEA: 5.2 mm. AEC dehiscence in 66.7%. Average distance between the artery middle point to the anterior nasal spine: 61.72 mm. Average distance from the nasal axilla: 64.04 mm. Average distance from the anterior axilla to the middle turbinate:21.14 mm.

[1] Address for correspondence Prof. Demetrio Milardi, Department of Biomedical, Dental Sciences and Morphological and Functional Images, Univeristy of Messina, Messina, Italy (e-mail: dmilardi@unime.it).

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In Vivo Computed Tomography Direct Volume Rendering of the Anterior Ethmoidal Artery: A Descriptive Anatomical Study

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