John J DePowell1, Sebastien C Froelich2, Lee A Zimmer3, James L Leach4, Alexandre Karkas5, Philip V Theodosopoulos6, Jeffrey T Keller7. 1. Department of Neurosurgery, University of Cincinnati (UC) Neuroscience Institute and UC College of Medicine, Cincinnati, Ohio, USA. 2. Department of Neurosurgery, Lariboisiere University Hospital, Paris, France. 3. Department of Otolaryngology-Head and Neck Surgery, Brain Tumor Center at the University of Cincinnati (UC) Neuroscience Institute and UC College of Medicine, Cincinnati, Ohio, USA. 4. Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. 5. Department of Otolaryngology - Head and Neck Surgery, University of Grenoble, Grenoble, France. 6. Department of Neurosurgery, University of Cincinnati (UC) Neuroscience Institute and UC College of Medicine, Cincinnati, Ohio, USA; Mayfield Clinic, Cincinnati, Ohio, USA. 7. Department of Neurosurgery, University of Cincinnati (UC) Neuroscience Institute and UC College of Medicine, Cincinnati, Ohio, USA; Mayfield Clinic, Cincinnati, Ohio, USA. Electronic address: editor@mayfieldclinic.com.
Abstract
BACKGROUND: The classic anatomic view of the course of the internal carotid artery (ICA) and its segments familiar to neurosurgeons by a 3-dimensional microscopic cranial view may be challenging to understand when seen in the unique 2-dimensional view of transnasal endoscopic surgery. OBJECTIVE: We re-examined our 1996 classification of 7 (C1-C7) segments of the ICA, comparing the arterial course in cadaveric dissections for both a transnasal endoscopic transpenoidal approach and frontotemporal craniotomy. METHODS: Five formalin-fixed cadaveric heads injected with colored silicone underwent thin-cut computed tomographic scanning for bony and vascular analysis. The ICA's intracranial course viewed by transnasal endoscopic dissection was compared with the view of a bilateral frontotemporal crantiotomy, from the petrous (C2) to communicating (C7) segments. RESULTS: Refinement of our 1996 ICA classification provides an anatomical understanding for endoscopic exposures transnasally along an inferior skull base trajectory. The changing course of the ICA, initially termed loop is now termed bend (i.e., implying a change in direction). Four bends are described as the ICA enters into the skull base as C2, C3-C4, C4, and C4-C5. We discuss delineation of certain problematic ICA segments and identify landmarks for endoscopic endonasal approaches. CONCLUSIONS: Our classification of the segments of the ICA achieves consistency without sacrificing either clinical or anatomic accuracy for either transcranial or endoscopic approaches. Universal application of this established nomenclature can avoid new and misleading terms, respects anatomical landmarks delineating segments, and provides a universal language for clear communication between disciplines.
BACKGROUND: The classic anatomic view of the course of the internal carotid artery (ICA) and its segments familiar to neurosurgeons by a 3-dimensional microscopic cranial view may be challenging to understand when seen in the unique 2-dimensional view of transnasal endoscopic surgery. OBJECTIVE: We re-examined our 1996 classification of 7 (C1-C7) segments of the ICA, comparing the arterial course in cadaveric dissections for both a transnasal endoscopic transpenoidal approach and frontotemporal craniotomy. METHODS: Five formalin-fixed cadaveric heads injected with colored silicone underwent thin-cut computed tomographic scanning for bony and vascular analysis. The ICA's intracranial course viewed by transnasal endoscopic dissection was compared with the view of a bilateral frontotemporal crantiotomy, from the petrous (C2) to communicating (C7) segments. RESULTS: Refinement of our 1996 ICA classification provides an anatomical understanding for endoscopic exposures transnasally along an inferior skull base trajectory. The changing course of the ICA, initially termed loop is now termed bend (i.e., implying a change in direction). Four bends are described as the ICA enters into the skull base as C2, C3-C4, C4, and C4-C5. We discuss delineation of certain problematic ICA segments and identify landmarks for endoscopic endonasal approaches. CONCLUSIONS: Our classification of the segments of the ICA achieves consistency without sacrificing either clinical or anatomic accuracy for either transcranial or endoscopic approaches. Universal application of this established nomenclature can avoid new and misleading terms, respects anatomical landmarks delineating segments, and provides a universal language for clear communication between disciplines.
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: 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