Objective To investigate the correlation between the anterior ethmoidal artery (AEA) and anatomical variations of the anterior cranial base, and to analyze the predictive factors for AEA suspension.

Methods Sinus CT imaging data of 159 patients undergoing endoscopic sinus surgery (ESS) were retrospectively analyzed. Mimics 21.0 software was utilized for three-dimensional reconstruction, measuring parameters of AEA and anterior cranial base anatomy and performing classification. Pearson and Spearman correlation analyses were used to evaluate the correlations among various anatomical parameters and their classifications. Multivariate binary logistic regression analysis was performed to screen for independentpredictive factors of AEA suspension.

Results The rates of AEA suspension differed significantly across different Keros classifications (P < 0.001), with an increase rate as the Keros classification level increased (P < 0.001). The transverse diameter, height and volume of supraorbital ethmoid cells (SOEC), olfactory fossa depth, lateral lamella of the cribriform plate (LLCP) length and frontal sinus pneumatization classification grade were positively correlated with the distance from AEA to the cranial base (P < 0.05). Multivariate binary Logistic regression analysis showed that the presence of SOEC (OR=4.178, 95%CI, 2.517 to 6.935, P < 0.001), increased olfactory fossa depth (OR=1.433, 95%CI, 1.197 to 1.715, P < 0.001), and higher frontal sinus pneumatization classification grade (OR=1.621, 95%CI, 1.121 to 2.345, P=0.01) were independent predictive factors for AEA suspension.

Conclusion Detailed preoperative CT imaging assessment, especially the analysis of SOEC, olfactory fossa depth and frontal sinus pneumatization classification, aids in accurately assessing the anatomical position of AEA, thereby effectively reducing the risk of AEA injury, and improving the safety and success rate of surgery.