Morphometric analysis of middle and posterior cranial fossae foramina in 3D reconstructions of CT images: A midline asymmetry evaluation

Year 2022, Volume: 35 Issue: 1, 42 - 47, 31.01.2022

Ural Verımlı Onur Bugdaycı Sercan Dogukan Yıldız Emrah Ozkılıc Nural Bekıroglu Omer Ozdogmus

https://doi.org/10.5472/marumj.1057384

Abstract

Objective: The cranial base harbours numerous foramina, and the anatomical properties of the foramina are crucial in clinical interventions. The purpose of the current study is to evaluate possible asymmetries regarding the middle and posterior cranial fossae foramina using 3D reconstructions of high-resolution computed tomography (CT) images.
Patients and Methods: High-resolution cranial CT images of 253 female and 287 male adult patients were used in the study. The patients were 18 to 40 years of age without any apparent cranial pathology. The distances from the foramen rotundum, foramen ovale, foramen spinosum, internal acoustic meatus, hypoglossal canal to the midline were measured bilaterally to compare both sides.
Results: The foramen spinosum and the mid-clival line measurements demonstrated statistically significant results favoring the right side (p=0.03, right mean 3.052 ± 0.253 cm, left mean 2.982 ± 0.193 cm). In males, the right foramen spinosum to mid-clival line measurements were significantly longer than the left side (p=0.027, right mean 3.150 ± 0.250 cm, left mean 3.070 ± 0.180 cm).
Conclusion: As predicted, the male measurements were significantly longer than the female measurements regardless of sides in all measurements. The measurements of cranial asymmetries may help describe anomalies and may contribute to the clinical approaches.

Keywords

Asymmetry, Computed tomography, Cranial fossa, Foramen, Midline

References

• Teul I, Czerwiński F, Gawlikowska A, Konstanty-Kurkiewicz V, Sławiński G. Asymmetry of the ovale and spinous foramina in mediaeval and contemporary sculls in radiological examinations. Folia Morphol (Praha) 2002;61:147-52.
• Shah SM, Joshi MR. An assessment of asymmetry in the normal craniofacial complex. Angle Orthod 1978;48:141-8. doi: 10.1043/0003-3219(1978)048<0141:AAOAIT>2.0.CO;2
• Bishara SE, Burkey PS, Kharouf JG. Dental and facial asymmetries: a review. Angle Orthod 1994;64:89-98. doi: 10.1043/0003-3219(1994)064<0089:DAFAAR>2.0.CO;2
• Khairnar KB, Bhusari PA. An anatomical study on the foramen ovale and the foramen spinosum. J Clin Diagn Res 2013;7:427-9. doi: 10.7860/JCDR/2013/4894.2790
• Di Ieva A, Bruner E, Haider T, et al. Skull base embryology: a multidisciplinary review. Childs Nerv Syst 2014;30:991-1000. doi: 10.1007/s00381-014-2411-x
• Choi JW, Ra YS, Hong SH, et al. Use of distraction osteogenesis to change endocranial morphology in unilateral coronal craniosynostosis patients. Plast Reconstr Surg 2010;126:995-1004. doi: 10.1097/PRS.0b013e3181e6c4b7
• Sandu K, Monnier P, Pasche P. Anatomical landmarks for transnasal endoscopic skull base surgery. Eur Arch Otorhinolaryngol 2011;269:171-8. doi: 10.1007/s00405-011-1698-4
• Marques SR, Ajzen S, D’ Ippolito G, Alonso L, Isotani S, Lederman H. Morphometric analysis of the internal auditory canal by computed tomography imaging. Iran J Radiol 2012;9:71-8. doi: 10.5812/iranjradiol.7849
• Rai AL, Gupta N, Rohatgi R. Anatomical variations of foramen spinosum. Innovative J Med Health Sci 2012;2:86-8
• Palacios E, MacGee EE. The radiographic diagnosis of trigeminal neurinomas. J Neurosurg 1972;36:153-6. doi: 10.3171/jns.1972.36.2.0153
• Krayenbuhl N, Isolan GR, Al-Mefty O. The foramen spinosum: a landmark in middle fossa surgery. Neurosurg Rev 2008;31:397- 401. doi: 10.1007/s10143-008-0152-6
• Ustun ME, Buyukmumcu M, Seker M, Karabulut AK, Uysal II, Ziylan T. Possibility of middle meningeal artery-to-petrous internal carotid artery bypass: an anatomic study. Skull base 2004;14:153-6. doi: 10.1055/s-2004-832258
• Ustun ME, Buyukmumcu M, Ulku CH, Guney O, Salbacak A. Transzygomatic-subtemporal approach for a middle meningeal-to-P2 segment of the posterior cerebral artery bypass: an anatomical and technical study. Skull base 2006;16:39-44. doi: 10.1055/s-2006-931622
• Krmpotić-Nemanić J, Vinter I, Kelovizć Z, Marusić A. Postnatal changes of the clivus. Ann Anat 2005;187: 277-80. doi: 10.1016/j.aanat.2004.11.005
• Oliveira E, Rhoton AL, Peace D. Microsurgical anatomy of the region of the foramen magnum. Surg Neurol 1985;24:293-352. doi: 10.1016/0090-3019(85)90042-4
• Pieper DR, LaRouere M, Jackson IT. Operative management of skull base malignancies: Choosing the appropriate approach. Neurosurg Focus 2002;12:1-8. doi: 10.3171/foc.2002.12.5.7
• Gurdal E, Cakmak YO, Ozdogmus O, et al. Morphometric measurements of the caudal cranial nerves in the petroclival region. J Neurol Surg A Cent Eur Neurosurg 2007;68:47-49. doi: 10.1055/s-2007-981463
• Sharma NA, Garud RS. Morphometric evaluation and a report on the aberrations of the foramina in the intermediate region of the human cranial base: A study of an Indian population. Eur J Anat 2011;15:140-9.
• Sharma NA, Garud RS. Foramina of the posterior cranial base: a study of adult Indian skulls. Rev Arg de Anat Clin 2011;3:89-98.
• Russo PP, Smith RL. Asymmetry of human skull base during growth. Int J Morphol 2011;29:1028-32
• Jain KK, Jain BK. Asymmetry in the skull. Acta Anat 1979;104:349-52. doi: 10.1159/000145082
• Sejrsen B, Jakobsen J, Skovgaard LT, Kjaer I. Growth in the external cranial base evaluated on human dry skulls, using nerve canal openings as references. Acta Odontol Scand 1997;55:356-64. doi: 10.3109/00016359709059200
• Lang J, Maier R, Schafhauser O. Postnatal enlargement of the foramina rotundum, ovale et spinosum and their topographical changes. Anat Anz 1984;156:351- 87. [24] Gupta T, Gupta SK. Original landmarks for intraoperative localization of the foramen ovale a radio-anatomical study. Surg Radiol Anat 2012;34:767-72. doi: 10.1007/s00276-011-0846-2
• Patil J, Kumar N, Mohandas Rao KG, Swamy Ravindra S. The foramen ovale morphometry of sphenoid bone in South Indian population. J Clin Diagn Res 2013;7:2668-70. doi: 10.7860/JCDR/2013/7548.3727
• Unver Dogan N, Fazliogullari Z, Uysal II, Seker M, Karabulut AK. Anatomical examination of the foramen of the middle cranial fossa. Int J Morphol 2014;32: 43-8
• Some MS, Murlimanju BV, Krishnamurthy A, Sridevi HB. An Anatomical Study of foramen spinosum in South Indian dry skulls with its emphasis on morphology and morphometry. Int J Anat Res 2015;3:1034-1038.
• Tewari S, Gupta C, Palomar V, Kathur SG. Morphometric Analysis of Foramen Spinosum in South Indian Population. Acta Med Iran 2018;56:113-8.
• Mohebbi A, Rajaeih S, Safari M, Omidian P. The sphenoid sinus, foramen rotundum and vidian canal: a radiological study of anatomical relationships. Braz J Otorhinolaryngol 2917;83:381-7. doi: 10.1016/j.bjorl.2016.04.013
• Rossi M, Ribeiro E, Smith R. Craniofacial asymmetry in development: an anatomical study. Angle Orthod 2003;73:381-5. doi: 10.1043/0003-3219(2003)073<0381:CAIDAA>2.0.CO;2
• Chen J, Xiao J. 2015. Morphological study of the pterygoid canal with high-resolution CT. Int J Clin Exp Med 2015;8:9484–90