Alexander Spiessberger1, Fabian Baumann2, Karl Friedrich Kothbauer2, Mohammed Aref3, Serge Marbacher4, Javier Fandino4, Edin Nevzati5. 1. Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland. Electronic address: alexander.spiessberger@ksa.ch. 2. Department of Neurosurgery, Luzerner Kantonsspital, Luzern, Switzerland. 3. Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, USA. 4. Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland. 5. Department of Neurosurgery, Luzerner Kantonsspital, Luzern, Switzerland; Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, USA.
Abstract
OBJECTIVE: The cervical carotid segment is used routinely as donor site for high-flow bypass procedures. The horizontal petrous segment would offer a shorter graft distance, complete graft protection intracranially, and avoid the need for surgical neck exposure. In a morphometric cadaveric study, we aimed to investigate variations of the petrous carotid anatomy, especially the incidence of bony dehiscence of the roof of the horizontal petrous carotid segment canal, which may facilitate exposure of the vessel and thereby potentially lower the morbidity of high-flow bypass procedures. METHODS: A subtemporal approach was used to expose the horizontal petrous internal carotid artery (ICA) on each side of 4 alcohol-embedded, silicone-injected human cadaver heads to perform a morphometric analysis of the vessel segment and surrounding bony anatomy. RESULTS: The following measurements were obtained of the horizontal petrous ICA (millimeters): long axis mean 9.6 (standard deviation [SD] 4.4, MIN 4.2, MAX 19.5), diameter mean 4.9 (SD 0.6, MIN 4, MAX 5.7), thickness of canal roof mean 2.1 (SD 1.7, MIN 0, MAX 5), and distance from temporal squama mean 22.5 (SD 6, MIN 17, MAX 35). Dehiscence of the bony roof of the horizontal petrous carotid canal was found in 25% of specimen investigated. CONCLUSIONS: A dehiscent bony roof of the horizontal petrous carotid canal potentially facilitates exposure of the vessel for high-flow bypass procedures and was observed in 25% of specimens. This feature could be identified on preoperative high-resolution imaging and thus aid in patient selection.
OBJECTIVE: The cervical carotid segment is used routinely as donor site for high-flow bypass procedures. The horizontal petrous segment would offer a shorter graft distance, complete graft protection intracranially, and avoid the need for surgical neck exposure. In a morphometric cadaveric study, we aimed to investigate variations of the petrous carotid anatomy, especially the incidence of bony dehiscence of the roof of the horizontal petrous carotid segment canal, which may facilitate exposure of the vessel and thereby potentially lower the morbidity of high-flow bypass procedures. METHODS: A subtemporal approach was used to expose the horizontal petrous internal carotid artery (ICA) on each side of 4 alcohol-embedded, silicone-injected human cadaver heads to perform a morphometric analysis of the vessel segment and surrounding bony anatomy. RESULTS: The following measurements were obtained of the horizontal petrous ICA (millimeters): long axis mean 9.6 (standard deviation [SD] 4.4, MIN 4.2, MAX 19.5), diameter mean 4.9 (SD 0.6, MIN 4, MAX 5.7), thickness of canal roof mean 2.1 (SD 1.7, MIN 0, MAX 5), and distance from temporal squama mean 22.5 (SD 6, MIN 17, MAX 35). Dehiscence of the bony roof of the horizontal petrous carotid canal was found in 25% of specimen investigated. CONCLUSIONS: A dehiscent bony roof of the horizontal petrous carotid canal potentially facilitates exposure of the vessel for high-flow bypass procedures and was observed in 25% of specimens. This feature could be identified on preoperative high-resolution imaging and thus aid in patient selection.
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: Paolo di Russo; Lorenzo Giammattei; Thibault Passeri; Arianna Fava; Eduard Voormolen; Anne Laure Bernat; Jean Pierre Guichard; Kentaro Watanabe; Sebastien Froelich Journal: Acta Neurochir (Wien) Date: 2022-06-25 Impact factor: 2.216