Surgical Anatomy of the Cribriform Plate and Adjacent Areas

Abstract

Continuous improvement of surgical techniques is needed in skull base surgery in order to decrease intraoperative complications during various operations. However, the basis of minimizing damage in the operative field is a comprehensive knowledge of microsurgical anatomy. This article provides a detailed description of the cribriform plate and adjacent areas, based on investigations of over one thousand dried skulls and 225 computerized tomography scans of the anterior skull base. The main anatomic structures and the different types of the cribriform plate are demonstrated on color photographs and identified on CT scans as well. The variations important in anterior skull base approaches are also discussed and compared with the data found in the literature. The surface anatomy and development of the cribriform plate is described.

Key words

Cribriform plate - anterior skull base - rhinobasis - topographic anatomy

References

• 1 Schmidt H M. Über Maße und Niveaudifferenzen der Medianstrukturen der vorderen Schädelgrube des Menschen.  Gegenbaurs morph Jahrb. Leipzig 1974;  120 538-559
• 2 Kawahara G, Matsuda M, Sugiyama K, Nakazawa R, Shima K. Studies on the Japanese lamina cribrosa-statistical observation on its shape, number of pores and area.  Japanese Zasshi Tokyo Ika Daigaku. 1968;  26 185-194
• 3 Keros P. Über die praktische Bedeutung der Niveauunterschiede der Lamina cribrosa des Ethmoids.  Z Laryngol Rhinol Otol Ihre Grenzgeb. 1962;  41 808-813
• 4 Lang J. Klinische Anatomie der vorderen Schädelgrube und ihrer angrenzenden Gebiete.  Eur Arch Otorhinolaryngol. 1993;  (Suppl 1) 3-36
• 5 Ónodi A. Die Nebenhöhlen der Nase. Hölder: Wien 1905
• 6 Kainz J, Stammberger H. The roof of the anterior ethmoid: A place of least resistence in the skull base.  Am J Rhinol. 1989;  4 191-200
• 7 Kainz J, Stammberger H. Danger areas of the posterior rhinobasis. An endoscopic and anatomical-surgical study.  Acta Otolaryngol (Stockh). 1992;  112 852-861
• 8 Stammberger H R, Kennedy D W. et al . Paranasal sinuses: anatomic terminology and nomenclature.  Ann Otol Rhinol Laryngol. 1995;  104 (Suppl 167) 7-16
• 9 Ohnishi T. Bony defects and dehiscences of the roof of the ethmoid cells.  Rhinology. 1981;  19 195-202
• 10 Wigand M E. Endoscopic Surgery of the Paranasal Sinuses and Anterior Skull Base. New York: Thieme Medical Publishers 1990
• 11 Williams P L, Bannister L H, Berry M M, Collins P, Dyson M, Dussek J E, Ferguson M WJ. Gray's Anatomy, 38th Edn. Edinburgh: Churchill Livingston 1995
• 12 Dirckx J H. (ed) .Stedman's Concise Medical Dictionary for the Health Professions, 3rd Ed. Baltimore, Maryland: Williams & Wilkins 1997: (on CD-Rom)
• 13 Gruber W. Die Crista galli des Os ethmoideum mit einer Höhle.  Arch Pathol Anat Physiol Klin Med. 1875;  65 11
• 14 Bašic N, Bašic V, Jukic T. et al . Computed tomographic imaging to determine the frequency of anatomical variations in pneumatization of the ethmoid bone.  Eur Arch Otorhinolaryngol. 1999;  256 69-71
• 15 Arslan H, Aydinlioglu , Bozkurt M, Egeli E. Anatomic variations of the paranasal sinuses: CT examination for endoscopic sinus surgery.  Auris Nasus Larynx. 1999;  26 39-48
• 16 Bolger W, Butzin C, Parsons D. Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery.  Laryngoscope. 1991;  101 56-64
• 17 Lang J. Klinische Anatomie des Kopfes. Berlin, Heidelberg, New York: Springer Verlag 1981
• 18 Ohnishi T, Yanagisawa E. Lateral lamella of the cribriform plate - an important high risk area in endoscopic sinus surgery.  Ear Nose Throat J. 1994;  74 688-690
• 19 Krmpotic-Nemanic J, Vinter I, Jalsovec D, Hat J. Relation of the ethmoidal cells to the floor of the anterior cranial fossa.  Ann Anat. 2000;  182 533-536
• 20 Jang Y J, Park H M, Kim H G. The radiographic incidence of bony defects in the lateral lamella of the cribriform plate.  Clin Otolaryngol. 1999;  24 440-442
• 21 Krmpotic-Nemanic J, Draf W, Helms J. Surgical anatomy of the head and neck. Berlin, Heidelberg, New York: Springer Verlag 1988
• 22 Ledouble A F. Traité des variations des os du crane. Paris: Vigot Frères 1903
• 23 Rhoton A. The anterior and middle cranial base.  Neurosurgery. 2002;  51 (Suppl 1) 273-302
• 24 Alyea O E van. Ethmoidal labyrinth. Anatomic study, with consideration of the clinical significance of its structural characteristics.  Arch Otolaryng. 1939;  29 881-902
• 25 Spee F von. Skeletlehre. 2. Abt.: Kopf. In: K. von Bardelebens Handbuch der Anatomie des Menschen. Jena: G. Fischer 1896
• 26 Moon H J, Kim H U, Lee J G, Chung I H, Yoon J H. Surgical anatomy of the anterior ethmoidal canal in ethmoid roof.  Laryngoscope. 2001;  111 900-904
• 27 Chung S K, Dhong H J, Kim H Y. Computed tomography anatomy of the anterior ethmoid canal.  Am J Rhinol. 2001;  15 77-81
• 28 Stieda L. Über den Sulcus ethmoidalis der Lamina cribrosa des Siebbeins.  Anat Anz. 1891;  8 232-237
• 29 Cummings C W. Otolaryngology: Head and Neck Surgery. 3rd edn. St. Louis: Mosby 1998
• 30 Mihálkovics G. Anatomie und Entwicklungsgeschickte der Nase und ihrer Nebenhöhlen. In: Handbuch der Laryngologie und Rhinologie. Wien 1896
• 31 Wolfgruber H. Über die Lamina cribrosa des Ethmoids.  Z Laryngol Rhinol Otol Ihre Grenzgeb. 1968;  47 522-529
• 32 Zuckerkandl E. Die Entwicklung des Siebbeins.  Verh Anat Ges Anat Anz Suppl. 1892;  7 261-264
• 33 Krmpotic-Nemanic J, Padovan I, Vinter I, Jalsovec D. Development of the cribriform plate and of the lamina mediana.  Ann Anat. 1998;  180 555-559
• 34 Anderhuber W, Walch C, Fock C. Configuration of ethmoid roof in children aged 0 to 14 years (in German).  Laryngo-Rhino-Otologie. 2001;  80 509-511
• 35 Jones T M, Almahdi J M, Bhalla R K, Lewis-Jones H, Swift A C. The radiological anatomy of the anterior skull base.  Clin Otolaryngol. 2002;  27 101-105
• 36 Teatini G, Simonetti G. et al . Computed tomography of the ethmoid labyrinth and adjacent structures.  Ann Otol Rhinol Laryngol. 1987;  96 239-246
• 37 Dessi P, Moulin G, Triglia J M, Zanaret M, Cannoni M. Differences in the height of the right and left ethmoid roofs: a possible risk factor for ethmoidal surgery. Prospective study of 150 scans.  J Laryngol Otol. 1994;  108 261-262
• 38 Lebowitz R A, Terk A, Jacobs J B, Holliday R A. Asymmetry of the ethmoid roof: Analysis using coronal computed tomography.  Laryngoscope. 2001;  111 2122-2124
• 39 Boenninghaus sen G. Die Operationen an den Nebenhöhlen der Nase. In: Katz L, Blumenfeld F. Handbuch der speziellen Chirurgie des Ohres und der obere Luftwege, 3rd edn. Leipzig: C. Kabitzsch 1923