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Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
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Frontal Ostium Grade (FOG): A New Computer Tomography Grading System for Endoscopic Frontal Sinus Surgery.

Heitham Gheriani1, Rami Al-Salman1, Al-Rahim R Habib1

  • 1St Paul's Sinus Centre, Division of Otolaryngology, University of British Columbia, Vancouver, British Columbia, Canada.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|May 6, 2020
PubMed
Summary

A new computed tomography (CT) grading system helps predict frontal sinus surgery difficulty based on ostium location. Anterior ostia are more challenging, impacting surgical time.

Keywords:
computerized tomographyendoscopic surgeryfrontal process maxillafrontal sinus ostiumlacrimal bonenasal process of the frontal bonespina nasalis interna

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Area of Science:

  • Rhinology
  • Neurosurgery
  • Medical Imaging

Background:

  • The frontal sinus ostium's location and size significantly influence surgical difficulty.
  • Anteriorly positioned ostia present greater surgical access challenges.

Purpose of the Study:

  • To introduce a novel computed tomography (CT) grading system for anatomical frontal ostium positioning.
  • To correlate CT grading with surgical difficulty and operative time in endoscopic frontal sinus surgery.

Main Methods:

  • A grading system was developed using specific sagittal CT cuts and reference lines (R-line and S-line).
  • The system categorizes frontal ostia as positive (anterior, easier access), negative (posterior, difficult access), or neutral.
  • 297 CT scans (594 ostia) were analyzed, followed by 90 frontal sinusotomies using the grading system.

Main Results:

  • 65% of ostia were grade positive, 8.75% grade negative, and 17.3% grade neutral.
  • Frontal sinusotomies took an average of 9.96 minutes for grade positive, 11.4 minutes for neutral, and 16.05 minutes for grade negative (P < .005).

Conclusions:

  • The proposed CT grading system effectively predicts the difficulty of endoscopic frontal sinus surgery.
  • This anatomical grading aids in surgical planning and managing patient expectations regarding operative complexity.