Anterior Ethmoidal Artery, Keros Classification, and Supraorbital Ethmoidal Cells Volume in Paranasal Sinus CT scans: Exploring Relationships and Correlations

This study aims to evaluate the relationships between the anterior ethmoidal artery (AEA) notch landmark, Keros classification, and the presence and volume of supraorbital ethmoidal cells (SOECs) to determine their anatomical correlations and surgical implications. A retrospective analysis of 102 paranasal sinus CT scans (204 sides) was performed. The AEA notch landmark was classified into three degrees based on its vertical distance from the skull base. The presence and volume of SOECs were recorded, and Keros classification was assessed. Correlations among these parameters were analyzed using Spearman's rank correlation coefficient, Chi-square, and Fisher's exact tests. SOECs were identified in 39.22% of cases, with a mean volume of 0.3535 ± 0.109 cm3 on the right side and 0.3399 ± 0.054 cm3 on the left. A significant correlation was observed between Keros classification and the AEA notch landmark (Spearman's rho = 0.637, p < 0.05). Additionally, SOEC volume showed a weak but significant correlation with the AEA notch landmark (Spearman's rho = 0.161, p < 0.05). However, there was no significant correlation between SOEC volume and Keros classification (p > 0.05). AEA positioning is significantly influenced by both its distance from the skull base and SOEC volume, though SOEC volume does not affect Keros classification. These insights contribute to a better understanding of endoscopic sinus surgery anatomy and may help minimize surgical risks.