A Consistent Endoscopic Landmark to Identify the Anterior Ethmoidal Artery

Area of Science:

• Otolaryngology
• Neurosurgery
• Surgical Anatomy

Background:

• Accurate identification of the anterior ethmoidal artery (AEA) is crucial for safe endoscopic sinus surgery.
• Existing methods for AEA localization often rely on navigation systems due to anatomical variations.
• A consistent endoscopic landmark for the AEA, independent of ethmoid cell variations, is needed.

Purpose of the Study:

• To describe and validate a novel, consistent endoscopic landmark for identifying the anterior ethmoidal artery (AEA).
• To assess the reliability of this landmark across diverse patient anatomies and clinical conditions.

Main Methods:

• Prospective enrollment of adult patients undergoing endoscopic frontal and ethmoid sinus surgery.
• Definition of the AEA landmark as a specific ridge on the ethmoid skull base.
• Validation using an image-navigation system as the gold standard, with concordance assessed by blinded rhinologists.

Main Results:

• The study analyzed 73 sides from 40 patients with various sinonasal diagnoses.
• The novel endoscopic landmark accurately identified the AEA in 97.3% of cases.
• When not precisely at the landmark, the AEA was located within 1 mm posteriorly.

Conclusions:

• A consistent endoscopic landmark for the anterior ethmoidal artery (AEA) has been identified.
• This landmark is reliable across different anatomical variations and clinical diagnoses in sinus surgery.
• The described landmark enhances surgical precision and reduces reliance on navigation for AEA identification.