Estudo tomográfico dos septos intraesfenoidais e de suas relações com a artéria carótida interna
Data
2015-09-24
Autores
Ramalho, Clauder Oliveira 
Orientadores
Zymberg, Samuel Tau
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: Septos intraesfenoidais são estruturas ósseas encontradas no interior dos seios esfenoidais. Quando possuem proximidade à artéria carótida interna podem aumentar o risco de lesão vascular durante a realização da cirurgia transesfenoidal expandida, na qual uma ampla esfenoidotomia com ressecção desses septos é necessária. Esse trabalho visa avaliar os septos intraesfenoidais e suas relações com a artéria carótida interna. Métodos: Tomografias de 421 pacientes sem história de doenças em seios paranasais e cirurgia endonasal foram analisadas. Os septos intraesfenoidais foram classificados em interesfenoidias e acessórios. A frequência da relação entre os septos e a artéria carótida interna foi descrita. Realizou-se também uma classificação dos seios esfenoidais em tipos 1 a 5, de acordo com a aeração em relação à sela turca, com objetivo de avaliar se há diferença nessa frequência para cada tipo de pneumatização sinusal. Resultados: Um total de 359 (85,3%) dos pacientes apresentavam septo interesfenoidal e 135 (37,6%) deles relacionavam-se à artéria carótida interna. Em seios tipo 4 e 5, essa relação chegou a 44,7 e 43,5%, respectivamente. Em seios tipo 3, essa relação foi de apenas 14,1%. Septos acessórios foram encontrados em 255 (60,6%) dos pacientes e 140 (54,9%) deles relacionavam-se à artéria carótida interna. Um total de 219 (52%) pacientes tinham achados tomográficos de qualquer tipo septo ligado à artéria carótida interna. Tipos 1 e 2, pela pouca aeração, não apresentavam essa relação. Entre apenas os seios tipo 3, 4 e 5, em 219 (62,4%) ela estava presente. Esses valores foram maiores que os descritos em estudos prévios, exceto por um trabalho. Conclusão: A alta frequência de septos intraesfenoidais relacionados à artéria carótida interna implica em uma atenção especial no estudo pré-operatório dessas estruturas, visando reduzir o risco de lesão vascular em cirurgia transesfenoidal expandida.
BACKGROUND AND PURPOSE: Intrasphenoid septations inserted in the carotid protuberance may increase the risk of vascular damage when an expanded transsphenoidal surgery is performed, in which an extensive sphenoidotomy with septum resection is required. The aim is to know the frequency of relationship between intrasphenoid septations and internal carotid artery (ICA). METHODS: CT scans of 421 patients with no previous history of paranasal sinus disease or endonasal surgery (mean age of 39±21.4 years) were analyzed. The intrasphenoid septations (classified as intersphenoid and accessory septa) and their relation with ICA were described. Also, a sphenoid sinus classification according to their degree of pneumatization was performed, in order to assess whether such classification influences the frequency of relationship between septa and ICA. RESULTS: A total of 359 (85.3%) patients had intersphenoid septa, and 135 (37.6%) of them were related to ICA. In type 4 and 5 sinuses, the frequency of intersphenoid septa related to ICA was respectively 44.7 and 43.5%, and only 14.1% for type 3. Accessory septa were found in 255 patients (60.6%) and 140 (54.9%) of them were related to ICA. An overall frequency of 219 (52%) patients with tomography findings of septum insertion into the carotid protuberances was found. Among 351 cases selected from only types 3, 4 and 5 sphenoid sinuses, 219 (62.4%) had a septum related to ICA. Types 1 and 2 had no intersphenoid septa related to ICA. CONCLUSION: The high frequency of intrasphenoid septa closely related to ICA justifies an appropriate pre-operatory study and careful attention during transsphenoidal surgery in order to reduce potentially serious vascular injuries
BACKGROUND AND PURPOSE: Intrasphenoid septations inserted in the carotid protuberance may increase the risk of vascular damage when an expanded transsphenoidal surgery is performed, in which an extensive sphenoidotomy with septum resection is required. The aim is to know the frequency of relationship between intrasphenoid septations and internal carotid artery (ICA). METHODS: CT scans of 421 patients with no previous history of paranasal sinus disease or endonasal surgery (mean age of 39±21.4 years) were analyzed. The intrasphenoid septations (classified as intersphenoid and accessory septa) and their relation with ICA were described. Also, a sphenoid sinus classification according to their degree of pneumatization was performed, in order to assess whether such classification influences the frequency of relationship between septa and ICA. RESULTS: A total of 359 (85.3%) patients had intersphenoid septa, and 135 (37.6%) of them were related to ICA. In type 4 and 5 sinuses, the frequency of intersphenoid septa related to ICA was respectively 44.7 and 43.5%, and only 14.1% for type 3. Accessory septa were found in 255 patients (60.6%) and 140 (54.9%) of them were related to ICA. An overall frequency of 219 (52%) patients with tomography findings of septum insertion into the carotid protuberances was found. Among 351 cases selected from only types 3, 4 and 5 sphenoid sinuses, 219 (62.4%) had a septum related to ICA. Types 1 and 2 had no intersphenoid septa related to ICA. CONCLUSION: The high frequency of intrasphenoid septa closely related to ICA justifies an appropriate pre-operatory study and careful attention during transsphenoidal surgery in order to reduce potentially serious vascular injuries
Descrição
Citação
RAMALHO, Clauder Oliveira. Estudo tomográfico dos septos intraesfenoidais e de suas relações com a artéria carótida interna. 2015. 63 f. Dissertação (Mestrado em Otorrinolaringologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2015.