Journal Article

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

Labib, Mohamed A., Kerr, Edward E., Abou Al-Shaar, Hussam, Corsten, Martin, Kassam, Amin, Prevedello, Daniel M., Carrau, Ricardo, Naudy, Cristian

2014

Overview

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 vesselʼs 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. ABBREVIATIONS:DOA, distal osseous archEEA, expanded endoscopic approachICA, internal carotid arteryLOCR, lateral opticocarotid recessLTR, lateral tubercular recessMOCR, medial opticocarotid recessSOF, superior orbital fissure

• Publisher: Copyright by the Congress of Neurological Surgeons
• Subject: Anatomic Landmarks - anatomy & histology / Cadaver / Carotid Artery, Internal - anatomy & histology / Humans / Neuroendoscopy - methods / Skull Base - blood supply / Skull Base - surgery