Endoscopic, endonasal variability in the anatomy of the internal carotid artery

Hélène Cebula; Almaz Kurbanov; Lee A Zimmer; Pavel Poczos; James L Leach; Juan Carlos De Battista; Sébastien Froelich; Philip V Theodosopoulos; Jeffrey T Keller

doi:10.1016/j.wneu.2014.09.021

Endoscopic, endonasal variability in the anatomy of the internal carotid artery

World Neurosurg. 2014 Dec;82(6):e759-64. doi: 10.1016/j.wneu.2014.09.021. Epub 2014 Sep 17.

Authors

Hélène Cebula¹, Almaz Kurbanov², Lee A Zimmer³, Pavel Poczos², James L Leach⁴, Juan Carlos De Battista⁵, Sébastien Froelich⁶, Philip V Theodosopoulos⁷, Jeffrey T Keller⁸

Affiliations

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.

PMID: 25238676
DOI: 10.1016/j.wneu.2014.09.021

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.

Keywords: Anatomic study; Classification; Endoscopic endonasal approaches; ICA segments; Pituitary gland.

MeSH terms

Cadaver
Carotid Artery, Internal / anatomy & histology*
Carotid Artery, Internal / surgery*
Carotid Body / anatomy & histology
Endoscopy / methods
Humans
Nasal Cavity / anatomy & histology*
Neurosurgical Procedures / methods
Pituitary Gland / anatomy & histology
Terminology as Topic