| Objective: According to the current imaging and anatomical studies on sphenoid sinus,internal carotid artery and the surrounding anatomys,there is a potential correlation between the position of internal carotid artery and the type and configuration of sphenoid sinus septum.However,the relationship between sphenoid sinus septum and internal carotid artery has not been described in details.In this study,image fusion technology was used to classify the types of sphenoid sinus septum.,so as to obtain a universally applicable classification method of sphenoid sinus septum,and analyzed the anatomical correlation between bone sphenoid sinus septum and C3 segment of internal carotid artery,so as to explore the relationship between sphenoid sinus separation and C3 segment of internal carotid artery during transsphenoidal approach surgery.Methods: Data of 110 patients undergoing surgery in the first affiliated hospital of China medical university from June 2014 to September 2019 were collected,including patient gender,age,pathology,tumor location,tumor size,surgical approach and other clinical informations.And included nasopharyngeal 3d-ct,magnetic resonance angiography and intraoperative endoscopic imaging data.According to the morphology and position of sphenoidal sinus separation in the CT coronal image,sphenoidal sinus septums was classified into "O","I","II","X" and "Y" types,and the angle between sphenoidal sinus septums and the midline was measured by photoshop.Then SPSS was used to analyze the correlation between various factors and whether the sphenoidal sinus septums points to C3 segment of the internal carotid artery,and the ROC curve was made based on the angle between the sphenoidal sinus septums and the midline,so as to determine the correlation between the angle between the sphenoidal sinus separation and the midline and directivity.Results: After excluding unqualified patients and patients with excessive invasion of sphenoidal sinus separation,a total of 96 patients were enrolled,and 29 patients were "y-type".22 cases were "type II".21 cases were "type I";11 cases were "type O";Seven cases were "type X".Except for type O,a total of 136 septations were analyzed in 85 patients,and statistical analysis showed that: 1.80% of the patients had at least one sphenoidal septum pointing to the internal carotid artery.The proper classification of sphenoidal sinus septum is helpful to understand the importance of sphenoidal sinus septum.According to the CT image of the sphenoidal sinus septum based on the C3 segment of the internal carotid artery in the coronary position,we obtained a generally applicable and practical intraoperative image classification method.2.Whether sphenoidal sinus septums points to C3 segment of internal carotid artery has no correlation with gender,age,pathological type,tumor location,tumor maximum diameter,surgical approach and other possible factors;3.ROC curve showed that the angle between sphenoidal sinus separation and the midline were closely correlated to the directivity(AUC = 0.665,95%ci: 0.551-0.778,P = 0.002),and the cut-off value was 15.35.Therefore,we believed that when the included Angle between sphenoidal sinus septum and the midline was greater than 15.35°,the probability of sphenoidal sinus septum pointing to ICA C3 segment was relatively high.Conclusion: 1 The C3 segment of the internal carotid artery is the most vulnerable part for neuroendoscopic transsphenoidal surgery 2.The Angle between the sphenoidal sinus separation and the midline is related to whether the sphenoidal sinus separation points to ICA.When the included Angle is greater than 15.35°,sphenoidal sinus separation can be used as an anatomical marker to determine the position of ICA.In endoscopic transsphenoidal surgery,the surgeon should pay full attention to it.We can use sphenoid sinus septum as a landmark of the internal carotid artery cavernous segment in transsphenoidal approach... |
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