蝶形骨洞前壁の分類と開放方法について

抄録

　Background:

　Endoscopic sinus surgery has become the standard surgical procedure for rhinosinusitis. However, there is no effective classification method for the opening of the sphenoid sinus. We reported the identification of the Onodi cell and classification of the sphenoid sinus using sagittal computed tomography (CT) for sphenoidotomy. We classified the anterior wall of sphenoid sinus into 4 types. Using sagittal CT, the relationships between the lateral side of the anterior wall of the sphenoid sinus and the optic nerve, and between the middle of the anterior wall of the sphenoid sinus and the skull base or pituitary gland were studied. Images were classified as demonstrating Skull base (without the Onodi cell), Optic canal, Sella, or Infra-Sella (all with the Onodi cell) type. This is very easy and useful classification for sphenoidectomy. Based on this identification, the operative procedures were classified into 4 types: olfactory approach (Type 1), ethmoidal approach (Type 2), both approach (Type 3), and median approach (Type 4). We examined the operative procedures in each of the 4 groups, classified on the basis of sagittal CT.

　We can recognize the critical area such as the optic canal and the internal carotid artery around the sphenoid sinus by understanding of this classification and prevent the serious injuries.