0:00

There are some very important anatomic neurovascular

0:05

structures that border along the perinasal sinuses

0:09

that are important to remember

0:10

because if there are areas of dehiscence

0:13

around these neurovascular structures,

0:16

it puts them at risk when the sinus surgeon is doing the

0:20

endoscopic resections.

0:22

So here you see the sphenoid science demarcated by S

0:27

and the black arrows that you see more superiorly

0:32

are demonstrating the maxillary nerve in the frame

0:36

and rotund, which as you see can be very closely associated

0:40

with the sphenoid sinus.

0:42

The smaller black arrows are showing the vian canal.

0:47

Vian canal is another of the small nerves in the walls

0:50

of the perinasal sinuses

0:52

that could potentially be injured at the time

0:54

of sinus surgery.

0:57

In addition, we have here the anterior conoid process up at

1:01

the top, the anterior conoid process is the lateral border

1:06

to the optic canal.

1:08

So we would expect the optic nerve to be going

1:10

between the sphenoid sinus and the anterior conoid process.

1:15

Again, if that wall of the

1:18

optic nerve canal is descent,

1:20

then when the surgeon is up in the sphenoid sinus,

1:23

potentially he could injure the optic nerve

1:27

along the lateral walls of the sphenoid sinus

1:31

and the ethmoid sinus.

1:32

We often find the carotid arteries in the cavernous sinus,

1:36

so lateral to the sphenoid sinus.

1:39

We have all that big vascular stuff

1:41

that can bleed like crazy if the lateral wall

1:44

of the sphenoid sinus is injured

1:46

and there's entry into the cavernous sinus

1:49

or the carotid artery.

1:51

On this sagal reconstruction, this is anterior

1:54

and this is posterior with the sphenoid sinus here

1:56

and the frontal sinus Here, you notice

1:58

that there are little areas

2:00

where the bone is very thinned along the cribriform plate.

2:04

Thinning of the cribriform plate

2:06

or areas of dehiscence could allow the endoscopic science

2:10

surgeon to enter intracranial inadvertently.

2:14

That is, of course, a potential source for CSF leakage.

2:19

So while we are interpreting the sinus inflammation,

2:22

we are also making note of all

2:24

of these little anatomic variants

2:26

that might put the patient at risk

2:29

with a relatively inexperienced,

2:32

functional endoscopic sinus surgeon

2:34

who doesn't recognize these potential risks.