Clinical significance of bony anatomical landmarks for endoscopic endonasal skull base surgery

Objective To explore the clinical significance of bony anatomical landmarks in endoscopic endonasal skull base surgery.Methods One hundred skull base bone samples were measured for anatomical data,and the surgical videos of 172 patients undergoing endoscopic endonasal skull base surgery were retrospectively analyzed.The clinical significance of anatomical landmarks,such as middle turbinate,ethmoid sinus,bone process in the sphenoid sinus,and pterygoid process of sphenoid bone,were analyzed in preoperative diagnosis and treatments of problems during endoscopic endonasal skull base surgery.Results The distances between the bilateral medial pterygoid plates,the anterior margins of the occipital condyle,and lacerum foramina were 26.47,16.92,and 19.98 mm respectively.The distances from the optic canal to the foramen lacerum,foramen ovale,and medial margin of articular fossa of the mandible were 26,30,and 44 mm respectively.In the 172 patients with endoscopic endonasal skull base surgery,the complications related to the surgical approach included injury to the internal carotid artery and optic nerve in 1 patient each;other postoperative complications included cerebrospinal fluid leakage in 14,subarachnoid hemorrhage in 1,and died of meningitis in 1.The middle turbinate,ethmoid sinus,bone process in the sphenoid sinus,pterygoid process of the sphenoid bone and their adjacent structures were important anatomical landmarks for the endoscopic endonasal surgery of the anterior skull base,sellar region,clivus,cavernous sinus,subtemporal fossa and pterygoid fossa.Conclusion Anatomical landmarks in the skull base is important for guiding endoscopic endonasal skull base surgery and correctly confirming them is helpful to ensure the safety of the surgery.