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    A new ventricular index based on coronal brain magnetic resonance images in patients with idiopathic normal pressure hydrocephalus
    (Tubitak Scientific & Technological Research Council Turkey, 2023) Yilmazsoy, Yunus; Arslan, Serdar; Ozdemir, Adnan; Korkmazer, Bora; Kizilkilic, Osman; Kafadar, Ali Metin
    Background/aim: The aim of this study was to assess the effectiveness of a new quantitative index for the diagnosis of idiopathic normal pressure hydrocephalus. Materials and methods: This retrospective study was conducted at Istanbul University Cerrahpasa Medical Faculty between January 2016 and November 2022. A total of 31 patients diagnosed with idiopathic normal pressure hydrocephalus were included in the study group and 48 patients were included in the control group. Measurement via the new Index was performed on a coronal section of magnetic resonance imaging at the level of the anterior commissure. Results: The new Index's mean diagnostic performance was 1.16 +/- 0.08 in the study group, significantly lower (p < 0.0001) than the mean of 1.43 +/- 0.10 in the control group. When a cutoff value of 1.23 was used for the new index, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rates were 96.1%, 90.7%, 80.6%, 98%, and 91.3%, respectively. Conclusion: The new Index described here is an effective, feasible, reproducible, highly sensitive, and specific quantitative method that can contribute to the improved diagnosis of patients with idiopathic normal pressure hydrocephalus.
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    Deficits in peripheric and central olfactory measurements in smokers: evaluated by cranial MRI
    (Springer, 2023) Sarikaya, Pelin Zeynep Bekin; Muluk, Nuray Bayar; Baser, Selcuk; Ozdemir, Adnan; Yilmazsoy, Yunus
    Objectives Cigarette smoking remains a serious health problem all over the world. We investigated the peripheral and central olfactory pathways in young male smokers to determine whether there is a relationship between the amount of cigarettes smoked and duration of smoking and the dimensions of the olfactory areas. Methods In this retrospective study, cranial Magnetic Resonance Imaging (MRI) images of adult male smokers aged <= 40 years (n = 51) and 50 healthy male adults were analyzed. The olfactory bulbus (OB) volumes and olfactory sulcus (OS) depths, insular gyrus, and corpus amygdala areas were measured via cranial MRI. In the smoker group, the number of cigarettes smoked and duration of smoking were noted and the Brinkmann index was calculated. Results OB volume, OS depth, and the insular gyrus areas of the smokers were lower than in the control group (p < 0.05). There were no differences between the groups in terms of the corpus amygdala measurements (p > 0.05). No significant correlations were found between the number of cigarettes smoked daily, smoking duration, and the Brinkmann index and the peripheral and central olfactory measurements in our study (p > 0.05). Conclusions In smokers, OB volumes, the OS, and the central areas decrease bilaterally, regardless of smoking duration and number of cigarettes smoked daily. This could be related to inflammatory mediators that may be harmful to the olfactory neuroepithelium, gray matter atrophy in the brain, or endothelial damage related to smoking and its effects on blood support to the brain and olfactory regions.
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    Evaluation of optic nerve sheath complex by magnetic resonance imaging in patients with idiopathic normal pressure hydrocephalus
    (Asean Neurological Assoc, 2023) Yilmazsoy, Yunus; Ozdemir, Adnan; Arslan, Serdar
    Background: We aimed to evaluate the optic nerve and optic nerve sheath diameter of patients with idiopathic normal pressure hydrocephalus with magnetic resonance imaging and to compare with the normal population. Methods: Magnetic resonance images and clinical records of the patients were retrospectively evaluated between 01.01.2015 and 01.01.2020. Twenty one patients in the normal pressure hydrocephalus group and 47 patients in the control group were included. Measurements were performed from the images obtained by creating multiplanar reconstructions from thin-slice Fast Spin Echo T2-weighted images. Measurements were made of optic nerve from the 3 mm posterior to the optic globe, on the plane which is oriented perpendicular to the nerve. Results: There was no difference between the two groups in terms of optic nerve diameters. Optic nerve sheath diameters are significantly higher in the normal pressure hydrocephalus group (p<0.0001). Conclusion: Morphological analysis of the optic nerve sheath complex which contains cerebrospinal fluid will contribute to the diagnosis and understanding chronic effects of normal pressure hydrocephalus, a disease in which changes in brain compliance and cerebrospinal fluid absorption are suspected in its etiology.
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    Evaluation of peripheral and central olfactory regions by MRI in patients with idiopathic intracranial hypertension
    (Taylor & Francis Ltd, 2023) Asal, Nese; Muluk, Nuray Bayar; Ozdemir, Adnan; Say, Bahar
    Objectives We investigated the peripheral and central smell regions in patients with idiopathic intracranial hypertension (IIH) by cranial MRI. Methods In this retrospective study, cranial MRI images of 43 adult patients with IIH (Group 1) and 43 healthy adults without IIH (Group 2) were included. In both groups, peripheral [Olfactory bulb (OB) volume and Olfactory sulcus (OS) depth] and central smell regions (insular gyrus and corpus amygdala area, and thalamus volume) were measured in cranial MRI. Results Bilateral OB volume and insular gyrus area, and right corpus amygdala and thalamus volumes of the IIH group were significantly lower than those of the control group (p < 0.05). In the IIH group, OB volume of the right side was significantly lower, and insular gyrus area of the right side was significantly higher than those of the left side (p < 0.05). In the IIH group, there were positive correlations between OB volumes; OS depths; insular gyrus areas; corpus amygdala areas; and thalamus volumes bilaterally (p < 0.05). In older patients, right OS depth and right corpus amygdala area decreased (p < 0.05). Conclusion In conclusion, IIH may be related to olfactory impairment. Cranial MRI images showed a decrease in peripheral (OB volume) and central (insular gyrus and corpus amygdala area and thalamus volume) smell regions. To prevent olfactory impairment in IIH patients, treatment should be done in IIH patients to decrease intracranial pressure. It is very important to prevent the circulation of CSF with increased pressure between the sheets of the olfactory nerve in IIH patients.
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    Evaluation of the medial rectus muscle and optic nerve using strain and shear wave elastography in Graves' patients
    (SPRINGER, 2020) Ozdemir, Adnan; Sahan, Mehmet H.; Asal, Nese; Inal, Mikail; Gungunes, Askin
    Purpose The purpose of this study was to describe the elastic properties of the medial rectus muscle and optic nerve in Graves' patients without clinically apparent ophthalmopathy using strain elastography (SE) and shear wave elastography (SWE) and to determine whether these elastic properties could be used to aid in the diagnosis of the medial rectus muscle or optic nerve involvement. Materials and methods Thirty participants diagnosed with Graves' disease without ophthalmopathy and 30 healthy volunteers (control group) were prospectively examined between November 2018 and August 2019. SE and SWE findings in both groups were compared using the chi(2)test and the independent samplesttest. Results A statistically significant softening of the medial rectus muscle was observed in the SE patterns of the Graves' patients (p = 0.009). A statistically appreciable distinction was observed between the medial rectus muscle (7.64 +/- 2.1 and 9.20 +/- 1.7 kPa,p = 0.000) and the optic nerve (8.35 +/- 2.8 and 9.37 +/- 1.5 kPa,p = 0.019) in the SWE modulus of the Graves' patients and healthy volunteers. Conclusion SE and SWE can be used to identify structural alterations to the medial rectus muscle and optic nerve before clinically apparent Graves' ophthalmopathy has developed.
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    Important landmarks and distances for posterior fossa surgery measured by temporal MDCT
    (SPRINGER, 2020) Burulday, Veysel; Bayar Muluk, Nuray; Komurcu Erkmen, Selmin Perihan; Akgul, Mehmet Huseyin; Ozdemir, Adnan
    In this retrospective study, we aimed to present important anatomical structures and distances for posterior fossa surgery by temporal multidetector computed tomography (MDCT). The temporal MDCT images of 317 adult patients (158 males and 159 females) were retrieved from the hospital's picture archiving and communication system (PACS). In the coronal temporal MDCT views, the cochlea-carotid canal and jugular bulb-mastoid bone outer surface were measured. In the axial MDCT views, the carotid canal-jugular bulb and carotid canal-posterior fossa distances were measured; the carotid canal and jugular bulb anterior-posterior (AP) and transverse dimensions were also measured. The bilateral cochlea-carotid canal, jugular bulb-mastoid bone outer surface, and right carotid canal-jugular bulb distances were significantly greater in the males than those in the females (p < 0.05). The carotid canal-posterior fossa distance was not different in both genders (p > 0.05). The carotid canal-jugular bulb and the carotid canal-posterior fossa distances were greater on the left side than those on the right side in both genders (p < 0.05). In males, the outer surface distance was greater on the left jugular bulb-mastoid bone than that on the right side of that bone (p < 0.05). The difference between the carotid canal AP dimensions was not significant between males and females (p > 0.05). However, the carotid canal transverse dimension, jugular bulb AP, and transverse dimensions were significantly greater in the males than those in the females, bilaterally (p < 0.05). In each gender separately, the carotid canal AP and transverse dimensions were greater on the left side and the jugular bulb AP and transverse dimensions were greater on the right side than those on the left side (p < 0.05). Positive correlations were found between the cochlea-carotid canal, the jugular bulb-mastoid bone outer surface, and the carotid canal-jugular bulb distances as well as between the jugular bulb-mastoid bone outer surface and the carotid canal-posterior fossa distances (p < 0.05). In older patients, the carotid canal-posterior fossa distances were shorter on the left side (p < 0.05). Vascular and neural localizations should be well understood in the operative area before applying the surgical approach in the posterior fossa. Computed tomography (CT) has a greater role in the evaluation of bone structures and vascular canals in this area.
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    Interobserver Agreement in the Analysis of Different Radiological Classifications of COVID-19 on Computed Tomography
    (Galenos Publ House, 2021) Ozdemir, Adnan; Yilmaz, Sevda; Erol, Ozlem Ozluk; Kaygusuz, Sedat; Goncuoglu, Alper; Erkmen, Selmin Perihan Komurcu; Karahan, Irfan
    Introduction: Computed tomography (CT) has approximately 98% sensitivity for Coronavirus disease-2019 (COVID-19). Various algorithms were designed using CT images. However, the interobserver agreement of different radiological classifications of COVID-19 is not yet known. Thus, this study aimed to investigate the interobserver agreement of different radiological classifications of COVID-19. Materials and Methods: This study included 212 patients who were positive on the polymerase chain reaction test and eligible for CT. Four radiologists examined all CT images simultaneously. They reached a consensus that CT images can provide definite findings of COVID-19. The Radiological Society of North America (RSNA) consensus statement, the British Society of Thoracic Imaging (BSTI) structured reporting statement, and COVID-19 Reporting and Data System (CO-RADS) were used. Fleiss' Kappa was used to detect interobserver agreement. Kappa values of 0.000.20 were considered as slight, 0.21-0.40 as fair, 0.41-0.60 as moderate, 0.61-0.80 as substantial, and 0.81-1.00 as near-perfect agreement, and p<0.05 was accepted as significant. Results: A total of 137 patients did not have any pathological CT findings. The most prevalent radiological findings were ground-glass opacities and consolidations. The agreements on all classifications were at near-perfect levels: RSNA, 0.86 (0.82-0.90); BSTI, 0.83 (0.79-0.87), and CO-RADS, 0.82 (0.79-0.86). The RSNA classification has the highest consistency rate, followed by BSTI and CO-RADS. However, substantial and moderate agreements were found in the subcategories of each classification. Conclusion: In this study, some subcategories had a lower agreement, despite the high consistency rates for COVID-19 radiological classification systems in the literature. Therefore, improving the items without consensus can lead to the development of better radiological diagnostic approaches.
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    Is there a relationship between Onodi cell and optic canal?
    (Springer, 2019) Ozdemir, Adnan; Muluk, Nuray Bayar; Asal, Nese; Sahan, Mehmet Hamdi; Inal, Mikail
    ObjectivesWe investigated the relationship between Onodi cells and optic canal by paranasal sinus computed tomography (PNSCT).MethodsIn this retrospective study, 508 PNSCT (265 males and 243 females) was examined. Onodi cell presence, pneumatization types, optic canal types; and also sphenoid sinusitis and anterior clinoid process pneumatization were evaluated.ResultsThe prevalence of Onodi cells was 21.2% of the patients. Onodi cells were observed 40.7% on the right side and 25.9% on the left side. In 33.4% of the patients, bilateral Onodi cells were present. Male/Female ratio was 24.5%/17.6%. Onodi cell types were detected as Type I>Type II>Type III bilaterally. There was a positive correlation between the right and left Onodi cell types (p<0.05). Optic canal types were detected as Type IV>Type I>Type II>Type III. bilaterally. There was a positive correlation between right and left optic canal types. Onodi cell presence and ACP pneumatization were found as statistically significant (p<0.05). In 65.5% of the patients, Onodi cells and ACP pneumatization were absent. ACP pneumatization was present in 35.4% of the cases. In nine cases, bilateral Onodi cells and ACP pneumatization were detected. Sphenoid sinusitis was detected in 11.4% of Type I and 13.8% of the Type II Onodi cells on the right side. On the left side, it was detected in 12.9% of the Type I and 19.0% of Type II Onodi cells.ConclusionIdentification of Onodi cell is very important clinically because of its proximity to optic nerve canal. We concluded that type IV Onodi-optic canal relationship was the most common finding in our study. Onodi cell presence and their patterns of pneumatization must be evaluated on PNSCT preoperatively to avoid optic canal damage.
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    Is there a relationship between sphenoid sinus pneumatization and carotid canal-intersinus septa connection?
    (Taylor & Francis Ltd, 2024) Ozdemir, Adnan; Muluk, Nuray Bayar; Sencan, Ziya
    ObjectivesWe investigated the relationship between sphenoid sinus (SS) pneumatization types, carotid canal types and carotid canal-intersinus septa connection.MethodsThe paranasal sinus computed tomography (PNSCT) images of 274 patients (141 males and 133 females) were evaluated retrospectively. SS pneumatization, SS intersinus septation, SS intersinus septa deviation, carotid canal classification, carotid canal dehiscence, carotid canal-intersinus septa connection and presence of Onodi cells were evaluated.ResultsIn presellar and sellar SS, type 1 carotid canal was detected. However, type 3 carotid canal was detected more in postsellar SS. On the left side, in 26.4% of the postsellar SS, carotid canal dehiscence was detected. On the right side, carotid canal-intersinus septa connection was detected in 55.8% of the postsellar SS and 35.1% of the sellar SS. On the left side, it was detected 58.3% of the postsellar SS and 30.9% of the sellar SS. In postsellar type SS pneumatized cases, right caroid canal-intersinus septa connection increased by 5.4 fold and left carotid canal-intersinus septa connection increased by 7.3 fold compared to presellar type SS pneumatization. In 2 >= intersinus septa group, left carotid canal-intersinus septa connection increased 5.0 fold compared to 'no septa' group.ConclusionIn this study, we evaluated SS pneumatization types and their relation with carotid canal types and carotid canal-intersinus septa connections. Type 3 carotid canal (protrudation to SS wall) was detected more in postsellar SS. In these cases, surgeons should be very careful during surgery to avoid damage to the internal carotid artery (ICA).
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    Maxillary sinus volume and mucosal thickening according to the septal deviation angle and age of the children
    (Sage Publications Ltd, 2023) Ozdemir, Adnan; Muluk, Nuray Bayar; Tursun, Serkan; Sencan, Ziya; Ozel, Gokce
    We examined the relationship between nasal septal deviation (SD) angle and maxillary sinus volumes by examining the paranasal sinus computed tomography (PNSCT) images in children. In this retrospective study, PNSCT images of 106 children with one-sided nasal SD were included. According to the SD angle, two groups were identified: Group 1 (n = 54): SD angle <= 11 degrees, Group 2 (n = 52): SD angle > 11 degrees. There were 23 children between 9 and 14 years and 83 children between 15 and 17 years. Maxillary sinus volume and mucosal thickening were evaluated. In 15- to 17-year age group, maxillary sinus volumes of males were higher than females bilaterally. For each of the males and females, ipsilateral maxillary sinus volume was significantly lower than the contralateral side in all children and in 15- to 17-year age group. In each of the SD angle values (<= 11 or >11) separately, ipsilateral maxillary sinus volume was lower; and in the SD angle > 11 degrees group, maxillary sinus mucosal thickening values were higher than those of the contralateral side. In young children in 9- to 14-year age group, bilateral maxillary sinus volumes decreased, in this group maxillary sinus volume was not affected according to the SD. However, in 15- to 17-year age groups, maxillary sinus volume was lower on the ipsilateral SD side; and ipsilateral and contralateral maxillary sinus volumes of the males were significantly higher than those in the females. SD should be treated at an appropriate time to prevent SD-related maxillary sinus volume shrinkage and rhinosinusitis.
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    Noticable Findings in Cranial MRI of the Patients with Idiopathic Intracranial Hypertension
    (Sage Publications Inc, 2022) Cankaya, Imran; Muluk, Nuray Bayar; Burulday, Veysel; Bilgili, M. Yasemin Karadeniz; Ozdemir, Adnan
    Objectives Idiopathic intracranial hypertension (IIH) is characterized by increased intracranial pressure. We investigated the optic nerve, Meckel's cavity, internal carotid artery (ICA) and pituitary findings of IIH by Cranial Magnetic Resonance Imaging (MRI). Methods Cranial MRI images of 35 adult patients with IIH and 35 adult subjects with normal cranial MRI results (control) were evaluated. Optic nerve diameter (OND), optic nerve sheat diameter (ONSD), OND/ONSD ratio, ON tortuosity, ON protrusion, posterior scleral flattening, ICA transverse diameter, CSF distance in Meckel's cavity and ICA transverse diameter/CSF distance in Meckel's cavity ratio, and pituitary gland measurements (height and transverse dimension; and Optic chiasm- pituitary gland distance) were measured. Results OND and ONSD of the IIH group were significantly higher than those of the control groups at anterior and posterior measurements (p < 0.05). OND/ONSD ratio of the IIH group was lower at anterior measurement; and higher at the posterior measurement than the control group (p < 0.05). Right ICA transverse diameter and bilateral CSF distance in Meckel's cavity of the IIH group were higher than those of the control. Optic chiasm- pituitary gland distance of the IIH group was significantly higher than that of the control group (p < 0.05). Conclusion OND/ONSD ratio is different in anterior and posterior measurements. So we recommend measuring OND and ONSD separately in IIH patients to use in the clinical practice. Similarly, optic chiasm-pituitary gland distance is also another point to note for IIH patients on MRI. Our paper adds new approach to IIH in terms of OND/ONSD ratio.
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    Pancreas and kidney changes in type 2 diabetes patients: the role of diffusion-weighted imaging
    (Tubitak Scientific & Technological Research Council Turkey, 2021) Sahan, Mehmet Hamdi; Ozdemir, Adnan; Asal, Nese; Karadeniz Bilgili, Yasemin Mirace; Dogan, Adil; Gungunes, Askin
    Background/aim: The aim of this study was to compare renal and pancreatic apparent diffusion-coefficient (ADC) values of diabetic patients and control subjects and to examine their potential association with several diabetes-related clinical parameters. Materials and methods: A total of 80 sex-and age-matched patients were included in the study. Of them, 40 were patients with type 2 diabetes and 40 were nondiabetic participants. Abdominal diffusion-weighted MRIs of both groups were retrospectively reviewed. Diabetes-related clinical parameters were recorded. Results: The difference between the mean ADC values of the patient group and the control group was significant (p = 0.012). It was also found that the mean pancreatic ADC values of diabetic patients and the control group significantly differed (p = 0.02). Besides, there were positive correlations between the mean pancreatic ADC values and age, Hb1Ac level, treatment type, and disease duration (p < 0.05). While eGFR values positively correlated with the mean renal ADC values (p < 0.05), there were negative correlations between such values and age, serum creatinine level, and disease duration (p < 0.05). Conclusion: Renal and pancreatic ADC values of diabetic patients could potentially play a role, as markers of renal and pancreatic functions, in clinical decisions in the follow-up of such patients.
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    Supraorbital ethmoid cells (SOECs), anterior ethmoid artery notch and ethmoid roof relation in PNSCT
    (Elsevier Sci Ltd, 2023) Ozdemir, Adnan; Muluk, Nuray Bayar; Sarikaya, Pelin Zeynep Bekin; Yilmazsoy, Yunus
    Objectives: We investigated supraorbital ethmoid cell (SOEC) presence and types in paranasal sinus computed tomography (PNSCT).Methods: The PNSCT images of 188 adult patients (93 males and 95 females) were evaluated as SOEC group (n = 87 sides), and non-SOEC group (n = 289 sides, control). In both groups, anterior ethmoid artery (AEA) notch-ethmoid roof distance and presence of AEA canal were evaluated. In the SOEC group, SOEC types (type 1 to 3) and SOEC angle are also examined.Results: SOEC was detected in 87 sides (23.13 %). SOEC type 2 was the most detected type (71.3 %). AEA notch-ethmoid roof distance of the SOEC group was significantly higher than those in the non-SOEC group. AEA notch-ethmoid roof distance of the SOEC Type 3 group was significantly higher than SOEC Type 2 group. AEA notch-ethmoid roof distance was 3.74 +/- 1.81 mm in the SOEC group and 0.68 +/- 1.16 mm in the non-SOEC group. When SOEC types were considered, this distance was 5.29 +/- 2.66 mm in type 3, 3.35 +/- 1.35 mm in type 2 and 3.48 +/- 0.92 mm in type 1. In higher SOEC types, SOEC angle; and AEA notch-ethmoid roof distance increased.Conclusion: In more pneumatized SOEC presence, SOEC angle increase, and AEA notch-ethmoid roof distance increases, AEA runs inferiorly in the ethmoid cells and freely below the skull base; and is more susceptible to injury. The surgeons should be more careful not to damage AEA in the FESS when detecting well-pneumatized SOECs (SOEC Type 3).
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    The Evaluation of the Cochlear Aqueduct and Internal Acoustic Canal in Patients with Unilateral Subjective Tinnitus and Normal Hearing
    (Aves, 2023) Yilmazsoy, Yunus; Muluk, Nuray Bayar; Ozdemir, Adnan; Sencan, Ziya
    Objective: We investigated the relationship between idiopathic subjective tinnitus and internal acoustic canal, cochlear aqueduct, vestibule, and lateral semicircular canal measurements by temporal magnetic resonance imaging. Methods: In this retrospective study, temporal magnetic resonance imaging sections of 25 patients (8 males and 17 females) with unilateral tinnitus and normal hearing were included. The internal acoustic canal, cochlear aqueduct, vestibule, and lateral semicircular canal measurements and internal acoustic canal and cochlear aqueduct shape classification were determined in the ipsilateral tinnitus side and contralateral non-tinnitus side. Results: The cochlear aqueduct length and width and internal acoustic canal opening width, length, width, and area of the ipsilateral tinnitus side were not different from the contralateral side. Similarly, the vestibule area and lateral semicircular canal height and width values were not different between the ipsilateral tinnitus side and the contralateral side. The main cochlear aqueduct type was type 2 in both ipsilateral and contralateral sides. For the internal acoustic canal types, cylindrical and funnel shapes were the most common types for the ipsilateral tinnitus side and contralateral side. There were positive correlations between the internal acoustic canal and vestibule areas; cochlear aqueduct length and internal acoustic canal areas; cochlear aqueduct width and width of the lateral semicircular canal; internal acoustic canal area and length and cochlear aqueduct length; internal acoustic canal opening width and height of the lateral semicircular canal; and width of the lateral semicircular canal dimensions. In older patients, the ipsilateral internal acoustic canal area was found to be smaller. Conclusions: In idiopathic subjective tinnitus, there were no important pathologies detected in the internal acoustic canal, cochlear aqueduct, vestibule area, and lateral semicircular canal. We concluded that there are no statistically significant morphometric differences compared to the healthy side in the internal acoustic canal, cochlear aqueduct, vestibule, and lateral semicircular canal areas detected by temporal magnetic resonance imaging in patients with unilateral subjective tinnitus and normal hearing.
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    The important adjacent structures for anterior ethmoidal artery in FESS: Anterior ethmoidal artery canal angle, supraorbital ethmoid cells and Keros classification
    (Elsevier Sci Ltd, 2022) Ozdemir, Adnan; Muluk, Nuray Bayar
    Objectives: This study investigated the visualization of the anterior ethmoidal artery (AEA) as notch, canal and sulcus, its relationship between supraorbital ethmoid cells (SOECs) and the Keros classification of the olfactory fossa on paranasal sinus computerized tomography (PNSCT). Methods: In this retrospective study, the paranasal sinus computerized tomography (PNsCT) images of 204 patients (103 males and 101 females) were analyzed. AEA canal, notch and sulcus, SOECs, the distance between AEA notch and ethmoid roof, AEA canal angle and Keros classification of the olfactory fossa were evaluated. Results: AEA notch in all patients and AEA canal (37.6 to 45.6%) and AEA sulcus (53.5 to 61.2%) were visualized. In the AEC canal and sulcus visualized patients, the Keros classification revealed higher. AEA notch and ethmoid roof distance increased in patients with higher Keros types. The presence of SOECs was significantly higher in males (41.7%) than females (19.8%) on the left side. There was a positive correlation between SOEC presence and Keros classification. In patients with SOEC, bilateral AEA canal and sulcus visualized more; and bilateral AEA notch and ethmoid roof distance increased. On the right side, the AEA canal angle of the males was significantly higher than that of the females. In patients with SOEC, the left AEA canal angle also increased. Conclusion: When detected SOECs and higher Keros types, the AEA was detected away from the skull base, AEA notch-ethmoid roof distance increased; and the AEA canal angle increased. To avoid intracranial penetrations, PNSCT should be evaluated carefully during the preoperative period.