Journal of Rhinology 2006;13(1):26-31.
Published online May 31, 2006.
Height and Shape of Skull Base as Risk Factors for Skull Base Penetration during ESS
Jong Cheol Lee, Myeong Sang Yu, Jae Yong Park, Han Sung Ko, Yoo Sam Chung, Bong Jae Lee, Yong Ju Jang
1Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. jangyj@amc.seoul.kr
2Department of Otolaryngology, Gangneung Asan Hospital, Gangneung, Korea.
두개저의 형태와 높이에 대한 고찰:부비동 내시경 수술 중 두개저 천공 발생 위험 인자로서의 비교
이종철, 유명상, 박재용, 고한성, 정유삼, 이봉재, 장용주
울산대학교 의과대학 서울아산병원 이비인후과학교실,1 강릉아산병원 이비인후과학교실2
Abstract
Background and Objectives
CT/MRI has identified several risk factors for life threatening complications of skull base penetration during endoscopic sinus surgery (ESS). We compared these risk factors in groups of patients with and without penetration.
MATERIALS AND METHODS
Retrospective review of direct coronal paranasal sinus computed tomography (CT) scans was done. Using preoperative CT scans of 100 patients without penetration, and 7 with penetration, we classified height into 4 groups and contour into 2 groups. The frequencies of shape and height differences of the right and left skull base were calculated in each group.
Results
6 of the 7 patients who had skull base penetration, ESS was performed by a resident or junior staff member having less than 3 years experience with this technique. Shape asymmetry was significantly higher in with penetration (4 out of 7 patients (57%)) and much less in without penetration (18 out of 100 patients, 18%, p=0.032). The frequencies of low skull base and height difference were seen in 15% and 28%, respectively.
Conclusion
The most important risk factor for inadvertent skull base penetration during ESS is the surgeon's experience and asymmetric shape of the right and left skull base.
Key Words: Fovea ethmoidalis;Skull base;Cribriform plate;Skull base defect;ESS


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