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<p>Injuries to the optic nerve during functional endoscopic sinus surgery (FESS) can result in devastating visual loss. The proximity of the optic nerve to the sphenoid sinus—and its wide anatomical variability—makes detailed preoperative radiological assessment essential. This study analyzes the anatomical relationships between the optic nerve and sphenoid sinus, with special attention to variants that increase surgical risk. Aims and Objectives: To study anatomical variations of the optic nerve in relation to the sphenoid sinus using high-resolution computed tomography (CT). This retrospective cross-sectional study was conducted on 200 non-sinus-related high-resolution CT scans (400 optic nerves) from adults aged 20–70 years. Axial, coronal, and sagittal bone-window images (≤ 1&#xa0;mm slice thickness) were reviewed. Each nerve was classified per Delano’s system; sphenoid pneumatization, optic canal dehiscence, and presence of Onodi cells were recorded. Descriptive statistics and chi-square tests were performed using SPSS v25.0, with significance at <i>p</i> &lt; 0.05. Our study revealed Delano Type I in 176 nerves (44%); Type II in 112 (28%); Type III in 72 (18%); and Type IV in 40 (10%). 50 of 72 Type III nerves (69.4%) were linked to sellar pneumatization. Optic canal dehiscence was observed in 58 nerves (14.5%). Onodi cells were present in 40 nerves (10%), most commonly with Type IV configurations. As far as symmetry is concerned, bilateral Delano Type concordance was seen in 156 patients (78%) and asymmetry was observed in 44 (22%). Delano Type I remains the most frequent variant, but higher risk configurations (Types II–IV) and optic canal dehiscence are more common than traditionally reported, especially among North Indians. The strong link between extensive sphenoid pneumatization and Type III nerve courses further elevates surgical risk. These findings reinforce the need for meticulous high-resolution CT evaluation—identifying side-specific anatomy and dehiscence—to guide safe sinus and skull base surgery.</p>

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Anatomical Intricacies of the Sphenoid Sinus in Kashmiri population: A Clinical Alert to Optic Nerve Vulnerability Using High-Resolution Computerised Tomography

  • 期刊论文

  • 发表日期：

    2026年1月19日

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  • Izat A Wani,
  • Mohammad S Dar,
  • Humaira Iftikhar,
  • Ghulam M Bhat

摘要

Injuries to the optic nerve during functional endoscopic sinus surgery (FESS) can result in devastating visual loss. The proximity of the optic nerve to the sphenoid sinus—and its wide anatomical variability—makes detailed preoperative radiological assessment essential. This study analyzes the anatomical relationships between the optic nerve and sphenoid sinus, with special attention to variants that increase surgical risk. Aims and Objectives: To study anatomical variations of the optic nerve in relation to the sphenoid sinus using high-resolution computed tomography (CT). This retrospective cross-sectional study was conducted on 200 non-sinus-related high-resolution CT scans (400 optic nerves) from adults aged 20–70 years. Axial, coronal, and sagittal bone-window images (≤ 1 mm slice thickness) were reviewed. Each nerve was classified per Delano’s system; sphenoid pneumatization, optic canal dehiscence, and presence of Onodi cells were recorded. Descriptive statistics and chi-square tests were performed using SPSS v25.0, with significance at p < 0.05. Our study revealed Delano Type I in 176 nerves (44%); Type II in 112 (28%); Type III in 72 (18%); and Type IV in 40 (10%). 50 of 72 Type III nerves (69.4%) were linked to sellar pneumatization. Optic canal dehiscence was observed in 58 nerves (14.5%). Onodi cells were present in 40 nerves (10%), most commonly with Type IV configurations. As far as symmetry is concerned, bilateral Delano Type concordance was seen in 156 patients (78%) and asymmetry was observed in 44 (22%). Delano Type I remains the most frequent variant, but higher risk configurations (Types II–IV) and optic canal dehiscence are more common than traditionally reported, especially among North Indians. The strong link between extensive sphenoid pneumatization and Type III nerve courses further elevates surgical risk. These findings reinforce the need for meticulous high-resolution CT evaluation—identifying side-specific anatomy and dehiscence—to guide safe sinus and skull base surgery.