title: Frontal Sinus Morphometry in Relation to Surgically Relevant Landmarks in the United States Population.
abstract: BACKGROUND
  Knowledge of frontal sinus morphometry is important in bifrontal, pterional, orbitozygomatic, and supraorbital craniotomies. Inadvertent frontal sinus violation can lead to infection, cerebrospinal fluid fistula, and mucocele formation. In particular, knowledge of anatomy in relation to surgically relevant landmarks can help surgeons perform these procedures more precisely and safely. We performed a descriptive radiographic analysis to better understand variations in frontal sinus anatomy.
  
  
  METHODS
  Using 3-dimensional reconstructive software, we analyzed 162 normal cranial computerized tomographic angiograms (from 80 men and 82 women). A line between the supraorbital notches (SONs) was used as a horizontal reference line (HRL). We recorded the maximum sinus height and width from the HRL and midline, respectively. In addition, sinus width was measured in relation to the SON at 0, 1, and 2 cm above the HRL.
  
  
  RESULTS
  The mean maximal sinus height from the HRL was 1.8 cm. The mean maximum sinus width was 2.6 cm (right and left) from midline and 0.46 cm (right) and 0.49 cm (left) from the SON. Less than 11% of sinuses were lateral to the SON at 2.0 cm above the HRL and <6% of sinuses were >1.5 cm lateral to the SON at 1.0 cm above the HRL.
  
  
  CONCLUSIONS
  Planned surgical corridors >1.5 cm lateral to the SON and/or >3.0 cm above the HRL are most likely to avoid the frontal sinus based on our radiographic measurements of normal sinus anatomy. Careful radiographic study and appropriate planning for more medial and/or inferior corridors is suggested.
authors.affiliation: Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Flanigan
authors.affiliation: Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Varun R
authors.initials: VR
authors.lastname: Kshettry
authors.affiliation: Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Mullin
authors.affiliation: Department of Neurosurgery, California Center for Pituitary Disorders, University of California, San Francisco, California, USA.
authors.forename: Arman
authors.initials: A
authors.lastname: Jahangiri
authors.affiliation: Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA; Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA; Section of Rhinology, Sinus, and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA. Electronic address: recinop@ccf.org.
authors.forename: Pablo F
authors.initials: PF
authors.lastname: Recinos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003399:Craniotomy / Q000379:methods*; D005260:Female; D005626:Frontal Sinus / Q000033:anatomy & histology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014481:United States; D055815:Young Adult
keywords: Craniometrics; Craniotomy; Frontal sinus; Morphometric; Neurosurgery; Skull base surgery; Supraorbital notch