A Road Map to the Internal Carotid Artery in Expanded Endoscopic Endonasal Approaches to the Ventral Cranial Base

Author:

Labib Mohamed A.1,Prevedello Daniel M.2,Carrau Ricardo3,Kerr Edward E.2,Naudy Cristian2,Abou Al-Shaar Hussam1,Corsten Martin4,Kassam Amin5

Affiliation:

1. Division of Neurosurgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada

2. Department of Neurosurgery

3. Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus, Ohio

4. Department of Otolaryngology, University of Ottawa, Ottawa, Ontario, Canada

5. Aurora Neuroscience Innovation Institute, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin

Abstract

Abstract BACKGROUND: Injuring the internal carotid artery (ICA) is a feared complication of endoscopic endonasal approaches. OBJECTIVE: To introduce a comprehensive ICA classification scheme pertinent to safe endoscopic endonasal cranial base surgery. METHODS: Anatomic dissections were performed in 33 cadaveric specimens (bilateral). Anatomic correlations were analyzed. RESULTS: Based on anatomic correlations, the ICA may be described as 6 distinct segments: (1) parapharyngeal (common carotid bifurcation to ICA foramen); (2) petrous (carotid canal to posterolateral aspect of foramen lacerum); (3) paraclival (posterolateral foramen lacerum to the superomedial aspect of the petrous apex); (4) parasellar (superomedial petrous apex to the proximal dural ring); (5) paraclinoid (from the proximal to the distal dural rings); and (6) intradural (distal ring to ICA bifurcation). Corresponding surgical landmarks included the Eustachian tube, the fossa of Rosenmüller, and levator veli palatini for the parapharyngeal segment; the vidian canal and V3 for the petrous segment; the fibrocartilage of foramen lacerum, foramen rotundum, maxillary strut, lingular process of the sphenoid bone, and paraclival protuberance for the paraclival segment; the sellar floor and petrous apex for the parasellar segment; and the medial and lateral opticocarotid and lateral tubercular recesses, as well as the distal osseous arch of the carotid sulcus for the paraclinoid segment. CONCLUSION: The proposed endoscopic classification outlines key anatomic reference points independent of the vessel's geometry or the sinonasal pneumatization, thus serving as (1) a practical guide to navigate the ventral cranial base while avoiding injury to the ICA and (2) further foundation for a modular access system.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Clinical Neurology,Surgery

Reference55 articles.

1. Expanded endonasal approach: the rostrocaudal axis;Kassam;Part I. Crista galli to the sella turcica. Neurosurg Focus,2005

2. Expanded endonasal approach: the rostrocaudal axis;Kassam;Part II. Posterior clinoids to the foramen magnum. Neurosurg Focus,2005

3. The front door to Meckel's cave: an anteromedial corridor via expanded endoscopic endonasal approach- technical considerations and clinical series;Kassam;Neurosurgery,2009

4. “Far-medial” expanded endonasal approach to the inferior third of the clivus: the transcondylar and transjugular tubercle approaches;Morera;Neurosurgery,2010

5. Extended endoscopic endonasal approach to the pterygopalatine fossa: anatomical study and clinical considerations;Cavallo;Neurosurg Focus,2005

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