가톨릭대학교 의과대학 이비인후과학교실
김민주, 이승훈, 장기홍, 전범조
Department of Otolaryngology-HNS, College of Medicine, The Catholic University of Korea, Seoul, Korea
Minju Kim, MD, Seunghoon Lee, MD, Kihong Chang, Beomcho Jun, MD
측두골 CT의 3차원 영상 합성을 이용한 외이도에 대한 S상 정맥동의 위치
The location of sigmoid sinus relating to the external auditory canal using three-dimensional image of temporal bone CT
J Korean Skull Base Society 8권 2호 : 5~9, 2013
Background/Purpose : This study is for the evaluate the location of sigmoid sinus relating to the external auditory canal using three-dimensional (3D) reconstruction image of temporal bone CT.
Methods : Twenty well pneumatized twenty temporal bone CT aged between 20 and 50 were selected. Three-dimensional reconstruction image were obtained with V-works 4.0 software program (Cybermed, Seoul, Korea) using axial scan of high-resolutional temporal bone CT. The horizontal length from suprameatal spine of Henle to anterior and posterior border of sigmoid sinus were measured. The horizontal length from bony inferior lateral external auditory canal to anterior and posterior border of sigmoid sinus were measured. The angle between horizontal suprameatal line and imaginary line acquired from two points which cross the center sigmoid sinus from above two horizontal lines was measured. The angle between bony inferior lateral external auditory canal and imaginary line acquired from two points which cross the center sigmoid sinus from above two horizontal lines was measured.
Results : The mean horizontal length from suprameatal spine of Henle to anterior and posterior border of sigmoid sinus were 16.24mm(±3.5) and 26.31mm(±4.1). The mean horizontal length from bony inferior lateral external auditory canal to anterior and posterior border of sigmoid sinus were 17.97mm(±5.8) and 29.47mm(±4.3). The mean angle between horizontal suprameatal line and imaginary line acquired from two points which cross the center sigmoid sinus was 80.82˚(±14.0).
The mean angle between bony inferior lateral external auditory canal line and imaginary line acquired from two points which cross the center sigmoid sinus was 90.53˚(±0.36).
Conclusion : The preoperative well understanding of sigmoid sinus location gave us a imaginary hint which avoid massive bleeding or morbidity before otologic or neurosurgery.
논문 접수일 : 2013년 11월 5일 심사 완료일 : 2013년 11월 30일
경기도 의정부시 금오동 65-1 의정부성모병원 이비인후과 Tel : 031-820-3657 Fax : 031-847-0038 E-mail : otojun@catholic.ac.kr
전 범 조
교신저자
temporal bone, sinus, sigmoid, external auditory canal
Key Words
원저1 증례1 증례2 증례3 증례4 증례5
▒ Introduction
The sigmoid sinus is a critical landmark during mastoid surgery in otologic field and also landmark during retrosigmoid approach in neurosurgical fields. This study is for the evaluate the location of sigmoid sinus relating to the external auditory canal using three-dimensional (3D) reconstruction image of temporal bone CT.
▒ Materials and Methods
Twenty well pneumatized twenty temporal bone CT aged between 20 and 50 were selected. Exclusion criteria were temporal bone fracture, history of middle ear and mastoid surgery, pathologic findings in middle ear and other systemic disease affecting development of skull. Three-dimensional reconstruction image were obtained with V-works 4.0 software program (Cybermed, Seoul, Korea) using axial scan of high-resolutional temporal bone CT(Fig. 1). The horizontal length from suprameatal spine of Henle to anterior and
3-D reconstructed image of temporal bone and sigmoid sinus 3dmarker indicates Henle spine (A) and bony inferior lateral point of EAC (B).
A
B Fig. 1
posterior border of sigmoid sinus were measured(Fig. 2A, B).
The horizontal length from bony inferior lateral external auditory canal to anterior and posterior border of sigmoid sinus were measured(Fig. 2C, D). The angle between horizontal suprameatal line and imaginary line acquired from two points which cross the center sigmoid sinus from above two horizontal lines was measured(Fig. 3A). The angle between bony inferior lateral external auditory canal and imaginary line acquired from two points which cross the center sigmoid sinus from above two horizontal lines was measured(Fig. 3B).
▒ Results
This study comprised 20 patients, 10 men and 10 women, with mean age of 41years, ranging from 21-54 years. A total temporal bones were analysed : 7 on the right side and 13 on the left side. The mean horizontal length from suprameatal spine of Henle to anterior and posterior border of sigmoid sinus were 16.24mm(±3.5) and 26.31mm(±4.1). The mean horizontal length from bony inferior lateral external auditory canal to anterior and posterior border of sigmoid sinus were 17.97mm(±5.8) and 29.47mm(±4.3). The mean angle between horizontal suprameatal line and imaginary line
acquired from two points which cross the center sigmoid sinus was 80.82˚(±14.0). The mean angle between bony inferior lateral external auditory canal line and imaginary line acquired from two points which cross the center sigmoid sinus was 90.53˚(±0.36).
The length from suprameatal spine of Henle to anterior(A) and posterior(B) border of sigmoid sinus, length from bony inferior lateral external auditory canal to anterior(C) and posterior border of sigmoid sinus(D).
A B C D
Fig. 2
A. The angle between horizontal suprameatal line and imaginary line acquired from two points which cross the center sigmoid sinus.
B. The angle between bony inferior lateral external auditory canal and imaginary line acquired from two points which cross the center sigmoid sinus.
A B
Fig. 3
Discussion
Understanding the complex and minute 3D anatomy of the temporal bone is a challenge for otologic Surgeons.1)
It is very important for the beginner as well as the experienced surgeon to be familiar with the precise relationships of the sigmoid sinus location and course.
Sigmoid sinus is the dural venous sinus that beginning at the end of the cerebellum tentorium, most of which is in the petrous portion of temporal bone. It goes to the inside inferior of the anterior and leads from the back of the jugular foramen to internal jugular vein.
It is well known that the position of the sigmoid sinus(SS) can be extremely variable within the mastoid bone.2-5)
As early as 1934, Meltzer6) described seven different positions of the SS.If the SS is located too anteriorly, it often makes tympanomastoid surgery difficult, especially during such neuro-otological procedures as translabyrinthine and retrolabyrinthine surgery.7, 8)
Suboccipital supratentorial approach, retrosigmoid approach, and midline/posterior suboccipital approach have been commonly applied in posterior fossa surgery.
It was emphasized that the corridors should be made as close to the transverse and sigmoid sinuses as possible to avoid severe complications such as hemorrhage induced by sinus injury.9, 10)
For this reason, the anatomical position of the SS and understanding the sigmoid sinus relating to the external auditory canal has great importance in preoperative evaluation prior to any mastoid surgery or neurosurgery such as retrosigmoid approach, suboccipital approach.
In 1995, A. Asian et al.11)found a significant relationship between position of the sigmoid sinus and regional mastoid pneumatization.
Similarly, Shatz and Sade12)found a significant relationship between the degree of mastoid pneumatization and the distance of the sigmoid sinus from the posterior border of the external ear canal in pneumatized mastoids.
In their study, they also found a significant difference between non-pneumatized and pneumatized mastoids
regarding the distance of SS from the posterior border of the external ear canal. Similarly, using high-resolution computed tomography, Ichijo et al.13)found that the distance between the posterior wall of the external auditory canal and the anterior edge of the SS was shorter in poorly pneumatized mastoids.
Shatz and Sade12)reported meadured the mean distance of the external auditory ear canal from the sigmoid sinus as 13.5
±2.8 mm in the control group.
Ichijo13)showed meaurments about distance between the external auditory canal and the anterior edge of the sigmoid sinus (DIST). In the ROM(right otitis media) group, the mean value of DIST for the affected side was 11.6mm and that for the healthy side was 14.4mm. In the LOM(Left otitis media) group, that for the affected side was 11.5mm and for the healthy side was 13.7mm.
Xing WW14)reported the distance from the anterior wall of sigmoid sinus to the posterior wall of external auditory meatus was 12.98±2.71mm.
We could find such a similar results, our meadured the mean distance of the external auditory ear canal from the anterior sigmoid sinus as 17.97±5.8mm.
In previous researches, the degree of mastoid pneumatization and the distance of the sigmoid sinus from the external auditory canal have been studied, yielding different results. This distance tends to have reduced in sclerotic mastoids with COM.12, 13, 15, 16)
M. Rajati et al.17)reported the mean distance of the spine of Henle from the sigmoid sinus was 15.27±3.3mm in the COM group, 16.92±3.23mm in the facial palsy group, and 14.53±
2.92mm in the cadaver temporal bone group.
In our study, the mean distance of the spine of Henle from the anterior sigmoid sinus was 16.24mm±3.5mm.
The purpose of this study is well understanding of sigmoid sinus location and related structures gave us a imaginary hint using 3D reconstructed image of temporal bone CT which avoid massive bleeding or morbidity and complication during otologic or neurosurgery.
Even if numerous studies have previously assessed relating
sigmoid sinus, the significance of the measured value in this study does not properly match data in the existing research.
So It is required to compare the measured value by 3D reconstruction and the actual value by cadevar study.
In conclusion, The sigmoid sinus courses anterior inferiorly in the supine position in operation fields. The preoperative well understanding of sigmoid sinus location gave us a imaginary hint which avoid massive bleeding or morbidity before otologic or neurosurgery.
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