Hélène Cebula1, Almaz Kurbanov2, Lee A Zimmer3, Pavel Poczos2, James L Leach4, Juan Carlos De Battista5, Sébastien Froelich6, Philip V Theodosopoulos7, Jeffrey T Keller8. 1. Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Department of Neurosurgery, Hautepierre University Hospital, Strasbourg, France. 2. Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Brain Tumor Center, University of Cincinnati Neuroscience Institute, Cincinnati, Ohio, USA. 3. Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Brain Tumor Center, University of Cincinnati Neuroscience Institute, Cincinnati, Ohio, USA. 4. Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. 5. Department of Neurosurgery, Pelegrina Hospital and Ossys Institut, Sección (Mendoza), Argentina. 6. Department of Neurosurgery, Lariboisiere University Hospital, Paris, France. 7. Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Brain Tumor Center, University of Cincinnati Neuroscience Institute, Cincinnati, Ohio, USA; Mayfield Clinic, Cincinnati, Ohio, USA. 8. Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Brain Tumor Center, University of Cincinnati Neuroscience Institute, Cincinnati, Ohio, USA; Mayfield Clinic, Cincinnati, Ohio, USA. Electronic address: mary.kemper@uc.edu.
Abstract
BACKGROUND: Classic three-dimensional schemas of the internal carotid artery (ICA) for transcranial approaches do not necessarily apply to two-dimensional endoscopic views. Modifying an existing ICA segment classification, we define endoscopic orientation for the lacerum (C3) to clinoid (C5) segments through an endonasal approach. METHODS: In 20 cadaveric heads, we classified endoscopic appearance based on shape and angulation of C3 to C5 segments. Distances were measured between both arteries, and between the ICA and pituitary gland. RESULTS: We identified 4 common ICA patterns: types I through III matched side-to-side, whereas type IV was asymmetric. In 80% of specimens, the pituitary gland had direct contact with the ICA. In 20% of specimens, a space existed between the pituitary gland and the cavernous segment. Access to the posterior aspect of the cavernous sinus medial to the cavernous segment was possible without retraction of the artery or pituitary gland. Spaces between the lacerum and cavernous segments were trapezoid (80%) and hourglass (20%). CONCLUSIONS: Distinguishing which ICA type courses between the lacerum and clinoid segments can help clarify the relationships between the artery and its surrounding structures during endoscopic approaches. Adapting the classic terminology of ICA segments provided consistency of endoscopic relevance, defined potential endoscopic corridors, and highlighted the critical step of arterial contact.
BACKGROUND: Classic three-dimensional schemas of the internal carotid artery (ICA) for transcranial approaches do not necessarily apply to two-dimensional endoscopic views. Modifying an existing ICA segment classification, we define endoscopic orientation for the lacerum (C3) to clinoid (C5) segments through an endonasal approach. METHODS: In 20 cadaveric heads, we classified endoscopic appearance based on shape and angulation of C3 to C5 segments. Distances were measured between both arteries, and between the ICA and pituitary gland. RESULTS: We identified 4 common ICA patterns: types I through III matched side-to-side, whereas type IV was asymmetric. In 80% of specimens, the pituitary gland had direct contact with the ICA. In 20% of specimens, a space existed between the pituitary gland and the cavernous segment. Access to the posterior aspect of the cavernous sinus medial to the cavernous segment was possible without retraction of the artery or pituitary gland. Spaces between the lacerum and cavernous segments were trapezoid (80%) and hourglass (20%). CONCLUSIONS: Distinguishing which ICA type courses between the lacerum and clinoid segments can help clarify the relationships between the artery and its surrounding structures during endoscopic approaches. Adapting the classic terminology of ICA segments provided consistency of endoscopic relevance, defined potential endoscopic corridors, and highlighted the critical step of arterial contact.
Authors: Carlo Serra; Nicolai Maldaner; Giovanni Muscas; Victor Staartjes; Athina Pangalu; David Holzmann; Michael Soyka; Christoph Schmid; Luca Regli Journal: Pituitary Date: 2017-12 Impact factor: 4.107
Authors: Saleem I Abdulrauf; Ahmed M Ashour; Eric Marvin; Jeroen Coppens; Brian Kang; Tze Yu Yeh Hsieh; Breno Nery; Juan R Penanes; Aysha K Alsahlawi; Shawn Moore; Hussam Abou Al-Shaar; Joanna Kemp; Kanika Chawla; Nanthiya Sujijantarat; Alaa Najeeb; Nadeem Parkar; Vilaas Shetty; Tina Vafaie; Jastin Antisdel; Tony A Mikulec; Randall Edgell; Jonathan Lebovitz; Matt Pierson; Paulo Henrique Pires de Aguiar; Paula Buchanan; Angela Di Cosola; George Stevens Journal: J Craniovertebr Junction Spine Date: 2016 Jul-Sep