Finding the Petroclival Carotid Artery: The Vidian–Eustachian Junction as a Reliable Landmark

Introduction Identifying the internal carotid artery (ICA) when managing petroclival and infratemporal fossa pathology is essential for the skull base surgeon. The vidian nerve and eustachian tube (ET) cartilage come together at the foramen lacerum, the vidian–eustachian junction (VEJ). The ICA position, relative to the VEJ is described. Methods Endoscopic dissection of adult fresh-frozen cadaver ICAs and a case series of patients with petroclival pathology were performed. The relationship of the VEJ to the ICA horizontal segment, vertical segment, and second genu was assessed. The distance of the ICA second genu to VEJ was determined in coronal, axial, and sagittal planes. The length of the vidian nerve and ET was measured from the pterygopalatine fossa (PPF) and nasopharyngeal orifice to the VEJ. Results In this study, 10 cadaver dissections (82.3 ± 6.7 years, 40% female) were performed. The horizontal petrous ICA was at or behind VEJ in 100%, above VEJ in 100%, and lateral to VEJ in 80%. The vertical paraclival segment was at or behind VEJ in 100%, above in 100%, and medial in 100%. The second genu was at or behind VEJ in 100% (3.3 ± 2.4 mm), at or above in 100% (2.5 ± 1.6 mm), and medial in 100% (3.4 ± 2.0 mm). The VEJ was successfully used to locate the ICA in nine consecutive patients (53.3 ± 13.6 years, 55.6% female) where pathology was also present. The VEJ was 15.0 ± 6.0 mm from the ET and 17.4 ± 4.1 mm from the PPF. Conclusion The VEJ is an excellent landmark as it defines both superior and posterior limits when isolating the ICA in skull base surgery.

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P14.10 Endoscopic skull base surgery for tumors invading internal carotid artery

Neuro-Oncology ◽

10.1093/neuonc/noz126.246 ◽

2019 ◽

Vol 21 (Supplement_3) ◽

pp. iii68-iii68

Author(s):

S Geng

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Skull Base ◽

Multimodal Imaging ◽

Internal Carotid ◽

Skull Base Surgery ◽

3 Dimensional ◽

Endoscopic Skull Base Surgery ◽

Vascular Structures ◽

The Relationship

Abstract BACKGROUND Internal carotid artery (ICA) injury is a disaster in endoscopic skull base surgery, so protection of internal carotid artery is an essential task. We use 3-dimensional multimodal imaging (3D-MMI) and intraoperative navigation (ION) in endoscopic skull base surgery to locate ICA and decrease ICA injury. MATERIAL AND METHODS 26 patients underwent endoscopic skull base surgery (pituitary adenomas, chordomas, neurinomas and other tumors invading internal carotid artery) guided by 3D-MMI and ION techniques to locate ICA. RESULTS In all patients, the 3D-MMI and ION techniques enabled adequate visualization of vascular structures stereoscopically, especially the relationship between lesion and ICA, and suplly real-time navigation to locate ICA during endoscopic skull base surgery. No ICA injury happened and neurosurgeons removed tumors with relaxed mind. CONCLUSION 3D-MMI and ION techniques were found to be helpful to locate internal carotid artery and decrease ICA injury during endoscopic skull base surgery.

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Management of the internal carotid artery in lateral skull base surgery: combine infratemporal fossa approaches with great saphenous vein reconstruction

10.1055/s-0038-1640315 ◽

2018 ◽

Author(s):

Z Gao

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Skull Base ◽

Saphenous Vein ◽

Internal Carotid ◽

Great Saphenous Vein ◽

Skull Base Surgery ◽

Infratemporal Fossa ◽

Lateral Skull Base

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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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A novel technique to manage internal carotid artery injury in endoscopic endonasal skull base surgery in the premise of proximal and distal controls

Neurosurgical Review ◽

10.1007/s10143-021-01517-1 ◽

2021 ◽

Author(s):

Limin Xiao ◽

Shenhao Xie ◽

Bin Tang ◽

Xiao Wu ◽

Han Ding ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Skull Base ◽

Internal Carotid ◽

Skull Base Surgery ◽

Carotid Artery Injury ◽

Endoscopic Endonasal ◽

Novel Technique ◽

Artery Injury ◽

Internal Carotid Artery Injury

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Utility of the Vidian Canal in Endoscopic Skull Base Surgery: Detailed Anatomy and Relationship to the Internal Carotid Artery

World Neurosurgery ◽

10.1016/j.wneu.2018.09.048 ◽

2019 ◽

Vol 121 ◽

pp. e140-e146 ◽

Cited By ~ 2

Author(s):

Mehmet Emin Adin ◽

Cihan Akgul Ozmen ◽

Nafi Aygun

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Skull Base ◽

Internal Carotid ◽

Skull Base Surgery ◽

Endoscopic Skull Base Surgery ◽

Vidian Canal

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Objective Validation of Perfusion-Based Human Live Cadaveric Simulation Training Model for Management of Internal Carotid Artery Injury in Endoscopic Endonasal Sinus and Skull Base Surgery

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1633612 ◽

2018 ◽

Vol 79 (S 01) ◽

pp. S1-S188

Author(s):

Gabriel Zada ◽

Jasper Shen ◽

Kevin Hur ◽

Paul Zhang ◽

Michael Minneti ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Skull Base ◽

Simulation Training ◽

Internal Carotid ◽

Skull Base Surgery ◽

Training Model ◽

Carotid Artery Injury ◽

Endoscopic Endonasal ◽

Internal Carotid Artery Injury

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The Carotid Artery

Otolaryngology ◽

10.1016/s0194-5998(05)80191-3 ◽

1995 ◽

Vol 112 (5) ◽

pp. P84-P84

Author(s):

Bruce W. Pearson ◽

Robert H. Wharen

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Skull Base ◽

Internal Carotid ◽

Skull Base Surgery ◽

Educational Objectives

Educational objectives: To better understand the preoperative and intraoperative risk to the internal carotid artery in neck and skull base surgery and to work more closely and knowledgeably with their neurovascular surgical colleagues in combined cases.

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Surgical Exposure of the Petrous Internal Carotid Artery: Practical Application for Skull Base Surgery

The Laryngoscope ◽

10.1097/00005537-199707000-00026 ◽

1997 ◽

Vol 107 (7) ◽

pp. 967-976 ◽

Cited By ~ 22

Author(s):

Leigh Anne Dew ◽

Clough Shelton ◽

H. Ric Harnsberger ◽

B. Gregory Thompson

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Skull Base ◽

Internal Carotid ◽

Skull Base Surgery ◽

Practical Application ◽

Surgical Exposure

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Management of an Internal Carotid Artery Injury During Open Skull Base Surgery With a Crushed Muscle Patch – Technical Note and Lessons Learned

Operative Neurosurgery ◽

10.1093/ons/opab267 ◽

2021 ◽

Author(s):

Jorn Van Der Veken ◽

Annika Reann Mascarenhas ◽

Steve Chryssidis ◽

Santosh Isaac Poonoose

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Skull Base ◽

Internal Carotid ◽

Skull Base Surgery ◽

Technical Note ◽

Lessons Learned ◽

Parent Vessel ◽

Lack Of Information ◽

Planum Sphenoidale

Abstract BACKGROUND Iatrogenic internal carotid artery (ICA) injury is a catastrophic complication in open skull base surgery. There is a lack of information regarding the most appropriate techniques on how to manage this complication. OBJECTIVE To highlight the difficulties encountered when an ICA injury arises intraoperatively and discuss the role and the potential pitfalls of the crushed muscle patch in the management of an ICA injury during open skull base surgery. METHODS In this technical video, we demonstrate the management of intraoperative ICA injury, which occurred during the resection of a diffuse planum sphenoidale meningioma via a left pterional craniotomy. RESULTS When isolation of the defect with temporary clips failed, we opted for a crushed muscle graft to plug the defect. Hemostasis was achieved, but because of prolonged pressure application and “overpacking,” the parent vessel was occluded. CONCLUSION The crushed muscle patch can be easily applied; however, care must be taken not to “overpack” and occlude the ICA.

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