Related Experiment Video
Updated: Jun 20, 2026
Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
Visualization of anterior skull base defects with intraoperative cone-beam CT
Gideon Bachar1, Emma Barker, Harley Chan
1Department of Otolaryngology-Head and Neck Surgery, Department of Surgical Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada. gidybahar@gmail.com
Background:
The role of cone-beam CT (CBCT) in demonstrating anterior skull base defects (ASBDs), differing in size and location, was investigated. The study was designed to describe the potential advantage of CBCT in the setting of an intraoperative cerebrospinal fluid (CSF) leak.
Methods:
In all, 120 ASBD were evaluated in 5 cadaver heads. Orthogonal and oblique slices were reconstructed. Observer studies assessed the visibility of ASBD in each location as a function of defect size.
Results:
For 1-, 2-, and 4-mm defects, the percentage that were undetectable ranged from 20% to 33%, 0% to 14%, and 0% to 5%, respectively. Confident breach detection increased with defect size and was most challenging in the lateral lamella and cribriform. CBCT permitted confident detection of ASBD as small as about 2 mm in the fovea ethmoidalis and planum. Oblique views were found to be superior to orthogonal planes.
Conclusions:
The ability to identify ASBD depended on the size and location of defect. Oblique viewing planes were optimal for ASBD visualization.
