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

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.