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3. The anterior cribriform plate foramina: from anatomy to surgery

Author

Patron, V., Roussel, L.M., Berkaoui, J., Hitier, M., Escallard, C., Humbert, M., Patron, V., Roussel, L.M., Berkaoui, J., Hitier, M., Escallard, C., and Humbert, M.

Abstract

Background: Despite the development of anterior skull base surgery, the anatomy of the nasal bone and anterior cribriform plate remains unclear. A recent study confirmed 2 distinct foramina in the anterior part of the cribriform plate: the ethmoidal slit (ES) and the cribroethmoidal foramen (CF). The aim of this study was to specify their content, their anatomic relationship to the frontal sinus and skull base, and their potential value in skull base surgery. Methods: Dissections were performed on 36 cadaver heads. Macro- and microscopic examinations were carried out. Microcomputed tomography scans contrasted with osmium were performed to identify vessels and nerves. Histology with neural, meningeal, or luteinizing hormone-releasing hormone immunomarkers was performed on the content of the foramina. Finally, endonasal surgical dissections were carried out. Results: The ES and the CF were observed in all cases. They measured a mean of 4.2 and 1.6 mm, respectively. The ES contained dura mater, arachnoid tissues, lymphatics, and the terminal nerve. The CF contained the anterior ethmoidal nerve and artery. This foramen continued forward with the cribroethmoidal groove, which measured a mean of 2.5 mm. This groove was under the frontal sinus and in front of the skull base. We also described a "cribroethmoidal canal" and a "nasal bone foramen." Clinical applications are discussed. Conclusion: The clinical applications of this new anatomic description concern both the cribriform plate and frontal sinus surgeries. Identifying the terminal nerve passing through the ES is a step forward in understanding pheromone recognition in humans.

Published
2022

9. The forgotten foramina: a study of the anterior cribriform plate.

Author

Patron V, Berkaoui J, Jankowski R, Lechapt-Zalcman E, Moreau S, and Hitier M

Subjects
Cadaver, Dissection methods, Dura Mater anatomy & histology, Endoscopy methods, Ethmoid Bone surgery, Female, Humans, Immunohistochemistry, Male, Neurosurgical Procedures methods, Olfactory Bulb anatomy & histology, Ethmoid Bone anatomy & histology, Ethmoid Bone pathology, Skull Base anatomy & histology
Abstract

Purpose: The olfactory cleft has garnered interest since the advent of endoscopic skull base surgery. Its precise anatomy, however, is still partially unknown. According to Rouvière, an "ethmoidal foramen" is located in its antero-medial part and contains a process of the dura mater. In a more lateral and anterior location, a second foramen, the "cribroethmoidal foramen", contains the anterior ethmoidal nerve. The aim of this study was to verify the existence of these elements and to establish landmarks for surgery., Methods: We performed an anatomical and histological study of eight olfactory clefts in four cadavers using both endonasal endoscopic and endocranial dissection., Results: An ethmoidal and a cribroethmoidal foramen were found in, respectively, 100 and 75% of cases. Their mean length was, respectively, 4.1 and 1.8 mm. They were located, respectively, in mean at 5.3 and 5.8 mm from the anterior ethmoidal artery., Conclusion: Our anatomical study demonstrates the existence of both foramina. The ethmoidal foramen clearly represents an area of least resistance in the anterior part of the olfactory cleft, which could predispose to anterior skull base cerebrospinal fluid leaks and meningoceles.

Published
2015
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