A road map to the internal carotid artery in expanded endoscopic endonasal approaches to the ventral cranial base

Authors

Mohamed A. Labib
Daniel M. Prevedello
Ricardo CarrauFollow
Edward E. Kerr
Cristian Naudy
Hassam Abou-Al Shaar
Martin Corsten
Amin B. Kassam, Advocate Aurora HealthFollow

Recommended Citation

Labib MA, Prevedello DM, Carrau R, Kerr EE, Naudy C, Abou-Al Shaar H, Corsten M, Kassam A. A road map to the internal carotid artery in expanded endoscopic endonasal approaches to the ventral cranial base. Neurosurgery. 2014 Sep;10(Suppl 3):448-71.

Affiliations

Aurora Neuroscience Innovation Institute

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: Anatomical dissections were performed in thirty-three cadaveric specimens (bilateral). Anatomical correlations were analyzed.

RESULTS: Based on anatomical correlations, the ICA may be described as six distinct segments: 1) parapharyngeal (common carotid bifurcation to ICA foramen); 2) petrous (carotid canal to posterlateral 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, Rosenmüller's fossa, 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 anatomical reference points independent of the vessel's geometry or the sinonasal pneumatization; thus, serving as: 1) a practical guide to navigate the ventral skull base while avoiding injury to the ICA, and 2) further foundation for a modular access system.

Document Type

Article

PubMed ID

24717685