The anatomy of the parapharyngeal segment of the internal carotid artery for endoscopic endonasal approach

Abstract BACKGROUND AND IMPORTANCE Iatrogenic internal carotid artery (ICA) injuries during endoscopic endonasal approach (EEA) surgeries are associated with a high morbidity and mortality, with few acceptable methods described for repair. CLINICAL PRESENTATION A 13-year-old girl with a large anterior and central skull base osteoblastoma incurred an iatrogenic cavernous ICA injury during a staged EEA approach. Intraoperative angiogram was performed with balloon-assisted EEA primary microsurgical repair of the lacerated ICA. CONCLUSION By integrating current techniques commonly used in open aneurysm surgeries and in endovascular procedures, we developed a rapid, safe technique to repair an EEA-associated iatrogenic ICA injury.

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Intracavernous branches of the internal carotid artery through an endoscopic endonasal approach: anatomical study and review of the literature

World Neurosurgery ◽

10.1016/j.wneu.2021.04.046 ◽

2021 ◽

Author(s):

Juan Ángel Aibar-Durán ◽

Fernando Muñoz-Hernández ◽

Carlos Asencio-Cortés ◽

Joan Montserrat-Gili ◽

Juan Ramón Gras-Cabrerizo ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Anatomical Study ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Review Of The Literature ◽

Endoscopic Endonasal

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Endoscopic endonasal approach for the treatment of a large clival giant cell tumor complicated by an intraoperative internal carotid artery rupture

Cancer Management and Research ◽

10.2147/cmar.s38768 ◽

2013 ◽

pp. 21 ◽

Cited By ~ 12

Author(s):

Maurizio Iacoangeli ◽

Di Rienzo ◽

Massimo Re ◽

Lorenzo Alvaro ◽

NiccolÃ² Nocchi ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Giant Cell Tumor ◽

Giant Cell ◽

Internal Carotid ◽

Cell Tumor ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Carotid Artery Rupture

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Analysis of the petrous portion of the internal carotid artery: Landmarks for an endoscopic endonasal approach

The Laryngoscope ◽

10.1002/lary.24594 ◽

2014 ◽

Vol 124 (9) ◽

pp. 1988-1994 ◽

Cited By ~ 6

Author(s):

Eric Mason ◽

Jose Gurrola ◽

Camilo Reyes ◽

Jimmy J. Brown ◽

Ramon Figueroa ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Petrous Portion

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The pterygoclival ligament: a novel landmark for localization of the internal carotid artery during the endoscopic endonasal approach

Journal of Neurosurgery ◽

10.3171/2017.12.jns172435 ◽

2019 ◽

Vol 130 (5) ◽

pp. 1699-1709 ◽

Cited By ~ 1

Author(s):

Ali Tayebi Meybodi ◽

Andrew S. Little ◽

Vera Vigo ◽

Arnau Benet ◽

Sofia Kakaizada ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Fibrous Tissue ◽

Petrous Apex ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Pterygoid Process ◽

The Mean

OBJECTIVEThe transpterygoid extension of the endoscopic endonasal approach provides exposure of the petrous apex, Meckel’s cave, paraclival area, and the infratemporal fossa. Safe and efficient localization of the lacerum segment of the internal carotid artery (ICA) is a crucial part of such exposure. The aim of this study is to introduce a novel landmark for localization of the lacerum ICA.METHODSTen cadaveric heads were prepared for transnasal endoscopic dissection. The floor of the sphenoid sinus was drilled to expose an extension of the pharyngobasilar fascia between the sphenoid floor and the pterygoid process (the pterygoclival ligament). Several features of the pterygoclival ligament were assessed. In addition, 31 dry skulls were studied to assess features of the bony groove harboring the pterygoclival ligament.RESULTSThe pterygoclival ligament was identified bilaterally during drilling of the sphenoid floor in all specimens. The ligament started a few millimeters posterior to the posterior end of the vomer alae and invariably extended posterolaterally and superiorly to blend into the fibrous tissue around the lacerum ICA. The mean length of the ligament was 10.5 ± 1.7 mm. The mean distance between the anterior end of the ligament and midline was 5.2 ± 1.2 mm. The mean distance between the posterior end of the ligament and midline was 12.3 ± 1.4 mm. The bony pterygoclival groove was identified at the confluence of the vomer, pterygoid process of the sphenoid, and basilar part of the occipital bone, running from posterolateral to anteromedial. The mean length of the groove was 7.7 ± 1.8 mm. Its posterolateral end faced the anteromedial aspect of the foramen lacerum medial to the posterior end of the vidian canal. A clinical case illustration is also provided.CONCLUSIONSThe pterygoclival ligament is a consistent landmark for localization of the lacerum ICA. It may be used as an adjunct or alternative to the vidian nerve to localize the ICA during endoscopic endonasal surgery.

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Extracapsular Pituitary Macroadenoma Resection and Internal Carotid Artery Aneurysm Clipping via Endoscopic Endonasal Approach: Technical Description

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1633769 ◽

2018 ◽

Vol 79 (S 01) ◽

pp. S1-S188

Author(s):

Javier Ospina ◽

Arif Janjua ◽

Peter Gooderham

Keyword(s):

Carotid Artery ◽

Internal Carotid ◽

Artery Aneurysm ◽

Pituitary Macroadenoma ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Aneurysm Clipping ◽

Carotid Artery Aneurysm ◽

Internal Carotid Artery Aneurysm

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Endoscopic endonasal approach for resection of pediatric chordoma with brainstem invasion

Neurosurgical Focus: Video ◽

10.3171/2019.10.focusvid.19421 ◽

2019 ◽

Vol 1 (2) ◽

pp. V20

Author(s):

Kumar Abhinav ◽

David Hong ◽

Carol H. Yan ◽

Peter Hwang ◽

Juan C. Fernandez-Miranda ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid ◽

Abducens Nerve ◽

Complete Resection ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Surveillance Imaging ◽

Pontine Lesion ◽

Postoperative Diagnosis

A 14-year-old boy had undergone an orbitozygomatic craniotomy for a pontine lesion. There was growth on surveillance imaging with involvement of posterior clinoids, clivus, and left pons suggestive of chordoma (Fernandez-Miranda et al., 2014b). An endoscopic endonasal approach was undertaken involving full upper and midclival exposure including bilateral posterior clinoidectomy (Fernandez-Miranda et al., 2014a; Truong et al., 2019a, 2019b). The internal carotid artery was skeletonized to maximize exposure and facilitate safe resection. The tumor was removed from between the dural layers of the midclivus while preserving the interdural abducens nerve (Barges-Coll et al., 2010). The brainstem component was resected while preserving the pontine perforators. Postoperative diagnosis was chordoma with MRI demonstrating complete resection. The patient was intact postoperatively.The video can be found here: https://youtu.be/g6SQ5JVK0Ko.

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Nasopharyngeal muscle patch for the management of internal carotid artery injury in endoscopic endonasal surgery

Journal of Neurosurgery ◽

10.3171/2019.7.jns191370 ◽

2020 ◽

Vol 133 (5) ◽

pp. 1382-1387 ◽

Cited By ~ 1

Author(s):

Wei-Hsin Wang ◽

Stefan Lieber ◽

Ming-Ying Lan ◽

Eric W. Wang ◽

Juan C. Fernandez-Miranda ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Skull Base ◽

Internal Carotid ◽

Skull Base Surgery ◽

Management Technique ◽

Endoscopic Endonasal Surgery ◽

Endonasal Surgery ◽

Endoscopic Endonasal ◽

Muscle Graft

OBJECTIVEInjury to the internal carotid artery (ICA) is the most critical complication of endoscopic endonasal skull base surgery. Packing with a crushed muscle graft at the injury site has been an effective management technique to control bleeding without ICA sacrifice. Obtaining the muscle graft has typically required access to another surgical site, however. To address this concern, the authors investigated the application of an endonasally harvested longus capitis muscle patch for the management of ICA injury.METHODSOne colored silicone-injected anatomical specimen was dissected to replicate the surgical access to the nasopharynx and the stepwise dissection of the longus capitis muscle in the nasopharynx. Two representative cases were selected to illustrate the application of the longus capitis muscle patch and the relevance of clinical considerations.RESULTSA suitable muscle graft from the longus capitis muscle could be easily and quickly harvested during endoscopic endonasal skull base surgery. In the illustrative cases, the longus capitis muscle patch was successfully used for secondary prevention of pseudoaneurysm formation following primary bleeding control on the site of ICA injury.CONCLUSIONSNasopharyngeal harvest of a longus capitis muscle graft is a safe and practical method to manage ICA injury during endoscopic endonasal surgery.

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