Rhinology
Published: 2023-12-29
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Type IV optic nerve and Onodi cell: is there a risk of injury during sphenoid sinus surgery?

Department of Otorhinolaryngology, University of Turin, “San Luigi Gonzaga” Hospital, Orbassano (TO), Italy
https://orcid.org/0000-0001-8111-7291
Department of Otorhinolaryngology, University of Turin, “San Luigi Gonzaga” Hospital, Orbassano (TO), Italy
https://orcid.org/0000-0001-8869-5916
 National Institute for Health, Migration and Poverty (INMP), Rome, Italy
 Department of Otorhinolaryngology, University of Turin, “San Luigi Gonzaga” Hospital, Orbassano (TO), Italy
 Otolaryngology Unit, “Santi Paolo e Carlo” Hospital, Department of Health Sciences, University of Milan, Milan, Italy
 Otolaryngology Unit, “Santi Paolo e Carlo” Hospital, Department of Health Sciences, University of Milan, Milan, Italy
https://orcid.org/0000-0003-1457-6871
Otorhinolaryngology, “A. Gemelli” Unversitary Hospital IRCCS, Rome, Italy
https://orcid.org/0000-0001-5761-7018
Department of Diagnostic Imaging, University of Turin, “San Luigi Gonzaga” Hospital, Orbassano (TO), Italy
Unit of Radiology, “A. Gemelli” University Hospital Foundation IRCCS, Rome, Italy
Department of Otorhinolaryngology, University of Turin, “San Luigi Gonzaga” Hospital, Orbassano (TO), Italy
Onodi cell optic nerve endoscopic sinus surgery sphenoid sinus computed tomography

Abstract

Objective. This study aims to determine the prevalence and types of Onodi cell through computed tomography and investigate the relationship between Onodi cell and the surrounding structures, paying particular attention to the risky proximity to the optic nerve canal.
Methods. In this study, 430 computed tomography scans of paranasal sinuses were analysed to establish the prevalence and different types of Onodi cell. Furthermore, the relationship between Onodi cell and different patterns of sphenoid sinus pneumatisation and surrounding structures were investigated. Special attention was paid to the relationship between Onodi cell and the optic nerve canal, particularly in cases when the optic nerve canal was bulging by more than 50% into Onodi cell (Type IV).
Results. The Onodi cell was detected in 21.6% of cases, with the most common being Type I (48.5% right, 54.3% left). Type IV bulging of the optic nerve canal into the Onodi cell was observed in 47.1% of cases on the right side, 41.2% on the left side and bilateral in 11.7% of cases.
Conclusions. In our series, we observed a high prevalence of Type IV optic nerve bulging into the Onodi cell. For this reason, we suggest that clinicians should always try to identify it in a pre-operative setting with computed tomography to avoid catastrophic consequences during endoscopic sinus surgery approaching the sphenoid area.

Affiliations

Gian Luca Fadda

Department of Otorhinolaryngology, University of Turin, “San Luigi Gonzaga” Hospital, Orbassano (TO), Italy

Anastasia Urbanelli

Department of Otorhinolaryngology, University of Turin, “San Luigi Gonzaga” Hospital, Orbassano (TO), Italy

Alessio Petrelli

 National Institute for Health, Migration and Poverty (INMP), Rome, Italy

Marta Trossarello

 Department of Otorhinolaryngology, University of Turin, “San Luigi Gonzaga” Hospital, Orbassano (TO), Italy

Letizia Nitro

 Otolaryngology Unit, “Santi Paolo e Carlo” Hospital, Department of Health Sciences, University of Milan, Milan, Italy

Alberto Maria Saibene

 Otolaryngology Unit, “Santi Paolo e Carlo” Hospital, Department of Health Sciences, University of Milan, Milan, Italy

Eugenio De Corso

Otorhinolaryngology, “A. Gemelli” Unversitary Hospital IRCCS, Rome, Italy

Dario Gned

Department of Diagnostic Imaging, University of Turin, “San Luigi Gonzaga” Hospital, Orbassano (TO), Italy

Marco Panfili

Unit of Radiology, “A. Gemelli” University Hospital Foundation IRCCS, Rome, Italy

Giovanni Cavallo

Department of Otorhinolaryngology, University of Turin, “San Luigi Gonzaga” Hospital, Orbassano (TO), Italy

Copyright

© Società Italiana di Otorinolaringoiatria e chirurgia cervico facciale , 2024

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