Mohamed A Labib1, Daniel M Prevedello, Ricardo Carrau, Edward E Kerr, Cristian Naudy, Hussam Abou Al-Shaar, Martin Corsten, Amin Kassam. 1. *Division of Neurosurgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; Departments of ‡Neurosurgery and §Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio; ¶Department of Otolaryngology, University of Ottawa, Ottawa, Ontario, Canada; ‖Aurora Neuroscience Innovation Institute, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin.
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.
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.
Authors: Ali Karadag; Pinar Gokdogan Kirgiz; Baran Bozkurt; Baris Kucukyuruk; Karim ReFaey; Erik H Middlebrooks; Mehmet Senoglu; Necmettin Tanriover Journal: Acta Neurochir (Wien) Date: 2021-04-13 Impact factor: 2.216
Authors: Gretchen M Oakley; Jareen Ebenezer; Aneeza Hamizan; Peta-Lee Sacks; Darren Rom; Raymond Sacks; Mark Winder; Andrew Davidson; Charles Teo; C Arturo Solares; Richard J Harvey Journal: J Neurol Surg B Skull Base Date: 2017-11-27
Authors: Marc Valera Melé; Anna Puigdellívol-Sánchez; Marija Mavar-Haramija; Juan A Juanes-Méndez; Luis San Román; Matteo De Notaris; Giuseppe Catapano; Alberto Prats-Galino Journal: Neurosurg Rev Date: 2018-07-26 Impact factor: 3.042
Authors: Marc Valera-Melé; Anna Puigdellívol-Sánchez; Marija Mavar-Haramija; Juan A Juanes-Méndez; Luis San-Román; Matteo de Notaris; Alberto Prats-Galino Journal: J Med Syst Date: 2018-03-05 Impact factor: 4.460