Cone Beam Computed Tomography (CBCT) Prevalence and Morphometry of Foramen Vesalius: A Systematic Review, Meta-Analysis, and Update of the Literature

TL;DR

This study reviews CBCT data to determine how often the foramen of Vesalius appears in the skull base and its size, finding significant variability across studies.

Contribution

The study provides updated prevalence and morphometric data of the foramen of Vesalius using CBCT and highlights the need for standardized reporting.

Findings

The prevalence of foramen Vesalius ranged from 28.1% to 73.1% across five CBCT studies.

The distance between foramen Vesalius and foramen ovale was typically 2–5 mm, while distances to foramen spinosum varied between 11–14 mm.

Current prevalence estimates are imprecise due to limited and inconsistent retrospective studies.

Abstract

Background: The foramen of Vesalius (FV; also known as the sphenoidal emissary foramen (SEF) or foramen venosum) is an inconstant skull-base foramen located near the foramen ovale. Its recognition may be relevant to percutaneous trigeminal procedures. Methods: This systematic review was registered in INPLASY (INOLASY2025100037; 11 October 2025) and conducted in accordance with PRISMA 2020. We searched PubMed, Scopus, and Web of Science from inception until December 2025 for English-language studies reporting the prevalence and/or morphometry of the foramen of Vesalius using cone-beam computed tomography (CBCT). Five reviewers screened and extracted data; prevalence studies were assessed for risk of bias using the Joanna Briggs Institute checklist. A random-effects meta-analysis of logit-transformed proportions was applied when ≥3 studies reported comparable prevalence outcomes. Results: Five retrospective CBCT studies (n = 1567) met the inclusion criteria. The prevalence of FV ranged from 28.1% (89/317; 95% CI 23.4–33.3) to 73.1% (190/260; 95% CI 67.4–78.1) throughout the cohorts. The total prevalence was 50.6% (95% CI 36.1–65.1), with significant variability (I2 = 96.8%) and a broad 95% prediction interval (19.5–81.3). The documented FV–FO distances were typically a few millimeters (about 2–5 mm), whereas the FV–foramen spinosum (FS) distances varied from approximately 11 to 14 mm, contingent upon the cohort and measuring technique employed. Conclusions: FV is frequently observable on CBCT when the skull base is within the field of view; nevertheless, current prevalence estimates lack precision because of the limited number of five retrospective investigations, which are inconsistent and clinic-based. Standardized definitions and reporting for CBCT, together with population-based cohorts, are crucial for improving clinically applicable prevalence and morphometric reference data.

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