The Superior Hypophyseal Arteries: Anatomical Study with an Endoscopic Endonasal Perspective

2019 ◽  
Vol 17 (3) ◽  
pp. 321-331 ◽  
Author(s):  
Francesco Doglietto ◽  
Daniel Monte-Serrat Prevedello ◽  
Francesco Belotti ◽  
Marco Ferrari ◽  
Davide Lancini ◽  
...  
Keyword(s):  
Internal Carotid ◽  
Optic Tract ◽  
Anatomical Study ◽  
Optic Chiasm ◽  
Pituitary Stalk ◽  
High Definition ◽  
Endoscopic Endonasal ◽  
Almost All ◽  
Internal Carotid Arteries ◽  
Number Of Branches

AbstractBACKGROUNDThe use of high-definition endoscopes in extended transsphenoidal approaches to the suprasellar area has significantly improved visualization of its vascularization.OBJECTIVETo systematically examine the superior hypophyseal arteries (SHAs) anatomy from an endonasal endoscopic perspective.METHODSThe endoscopic endonasal transsphenoidal trans-tuberculum approach was performed in 19 adult, fresh and latex injected specimens. Dissections recordings were reviewed to analyze SHAs type, number, and branches, as well as internal carotid arteries (ICA) branches that vascularized optic nerves and chiasm.RESULTSIdentification of SHAs was possible in all specimens (37/38 sides). The number of SHAs varied from 1 to 3 per side (mean: 1.7). The anterior superior hypophyseal artery was visible in almost all cases (35/37 sides) and originated at the level of the carotid cave in 18/35 specimens; number of branches ranged from 1 to 6 (mean: 3.5), directed to the optic nerve (86%), chiasm (57%), infundibulum (86%), and/or parallel to the pituitary stalk (74%). The 4 main branches and patterns, originally described by McConnell in 1953, were confirmed. The posterior superior hypophyseal artery was evident in 28/37 sides with number of branches ranging from 0 to 4 (mean: 2.1), directed to the optic chiasm (50%), optic tract (32%), infundibulum (79%), and/or pituitary stalk (36%). The surgical implications of this study, together with anatomical and clinical videos, are also briefly discussed.CONCLUSIONSHAs constitute a complex of anterior and posterior branches that stem from the medial ICA with different patterns, vascularizing the optic apparatus and pituitary stalk.

Paratrigeminal, Paraclival, Precavernous, or All of the Above? A Circumferential Anatomical Study of the C3-C4 Transitional Segment of the Internal Carotid Artery

2017 ◽  
Vol 14 (4) ◽  
pp. 432-440 ◽  
Author(s):  
Eleonora Marcati ◽  
Norberto Andaluz ◽  
Sebastien C Froelich ◽  
Lee A Zimmer ◽  
James L Leach ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Anatomical Study ◽  
Posterior Longitudinal Ligament ◽  
Petrous Apex ◽  
Meckel’S Cave ◽  
Endoscopic Endonasal ◽  
Meckel's Cave

Abstract BACKGROUND Although the term paraclival carotid pervades recent skull base literature, no clear consensus exists regarding boundaries or anatomical segments. OBJECTIVE To reconcile various internal carotid artery (ICA) nomenclatures for transcranial and endoscopic-endonasal perspectives, we reexamined the transition between lacerum (C3) and cavernous (C4) segments using a C1-C7 segments schema. In this cadaveric study, we obtained a 360°-circumferential view integrating histological, microsurgical, endoscopic, and neuroradiological analyses of this C3-C4 region and identified a distinct transitional segment. METHODS In 13 adult, silicone-injected, formalin-fixed cadaveric heads (26 sides), transcranial-extradural-subtemporal and endoscopic-endonasal CT­guided dissections were performed. A quadrilateral area was noted medial to Meckel's cave between cranial nerve VI, anterolateral and posterolateral borders of the lateral-paratrigeminal aspect of the precavernous ICA, and posterior longitudinal ligament. Endoscopically, a medial-paraclival aspect was defined. Anatomical correlations were made with histological and neuroradiological slides. RESULTS We identified a distinct precavernous C3-C4 transitional segment. In 18 (69%) specimens, venous channels were absent at the quadrilateral area, on the paratrigeminal border of the precavernous ICA. A trigeminal membrane, seen consistently on the superior border of V2, defined the lateral aspect of the cavernous sinus floor. The medial aspect of the precavernous ICA corresponded with the paraclival ICA. CONCLUSION Our study revealing the juncture of 2 complementary borders of the ICA, endoscopic endonasal (paraclival) and transcranial (paratrigeminal), reconciles various nomenclature. A precavernous segment may clarify controversies about the paraclival ICA and support the concept of a “safe door” for lesions involving Meckel's cave, cavernous sinus, and petrous apex.

scholarly journals Endoscopic endonasal control of the paraclival internal carotid artery by Fogarty balloon catheter inflation: an anatomical study

2017 ◽  
Vol 126 (3) ◽  
pp. 872-879
Author(s):  
Andrea Ruggeri ◽  
Joaquim Enseñat ◽  
Alberto Prats-Galino ◽  
Antonio Lopez-Rueda ◽  
Joan Berenguer ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Balloon Catheter ◽  
Anatomical Study ◽  
Endoscopic Endonasal ◽  
Cavernous Sinus Invasion ◽  
Neoplastic Lesions ◽  
Temporary Occlusion ◽  
Safe Approach

OBJECTIVE Neurosurgical management of many vascular and neoplastic lesions necessitates control of the internal carotid artery (ICA). The aim of this study was to investigate the feasibility of achieving control of the ICA through the endoscopic endonasal approach by temporary occlusion with a Fogarty balloon catheter. METHODS Ten endoscopic endonasal paraseptal approaches were performed on cadaveric specimens. A Fogarty balloon catheter was inserted through a sellar bony opening and pushed laterally and posteriorly extraarterially along the paraclival carotid artery. The balloon was then inflated, thus achieving temporary occlusion of the vessel. The position of the catheter was confirmed with CT scans, and occlusion of the ICA was demonstrated with angiography. The technique was performed in 2 surgical cases of pituitary macroadenoma with cavernous sinus invasion. RESULTS Positioning the Fogarty balloon catheter at the level of the paraclival ICA was achieved in all cadaveric dissections and surgical cases through a minimally invasive, quick, and safe approach. Inflation of the Fogarty balloon caused interruption of blood flow in 100% of cases. CONCLUSIONS Temporary occlusion of the paraclival ICA performed through the endoscopic endonasal route with the aid of a Fogarty balloon catheter may be another maneuver for dealing with intraoperative ICA control. Further clinical studies are required to prove the efficacy of this method.

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

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

scholarly journals Expanding the endoscopic transpterygoid corridor to the petroclival region: anatomical study and volumetric comparative analysis

2018 ◽  
Vol 128 (6) ◽  
pp. 1855-1864 ◽  
Author(s):  
Jacob L. Freeman ◽  
Raghuram Sampath ◽  
Steven Craig Quattlebaum ◽  
Michael A. Casey ◽  
Zach A. Folzenlogen ◽  
...  
Keyword(s):  
Internal Carotid ◽  
Anatomical Study ◽  
Petrous Apex ◽  
Endoscopic Endonasal ◽  
Petroclival Region ◽  
Lateral Skull Base ◽  
Before And After ◽  
Transcranial Approach ◽  
Temporal Bone Resection ◽  
Petrous Temporal Bone

OBJECTIVEThe endoscopic endonasal transmaxillary transpterygoid (TMTP) approach has been the gateway for lateral skull base exposure. Removal of the cartilaginous eustachian tube (ET) and lateral mobilization of the internal carotid artery (ICA) are technically demanding adjunctive steps that are used to access the petroclival region. The gained expansion of the deep working corridor provided by these maneuvers has yet to be quantified.METHODSThe TMTP approach with cartilaginous ET removal and ICA mobilization was performed in 5 adult cadaveric heads (10 sides). Accessible portions of the petrous apex were drilled during the following 3 stages: 1) before ET removal, 2) after ET removal but before ICA mobilization, and 3) after ET removal and ICA repositioning. Resection volumes were calculated using 3D reconstructions generated from thin-slice CT scans obtained before and after each step of the dissection.RESULTSThe average petrous temporal bone resection volumes at each stage were 0.21 cm3, 0.71 cm3, and 1.32 cm3 (p < 0.05, paired t-test). Without ET removal, inferior and superior access to the petrous apex was limited. Furthermore, without ICA mobilization, drilling was confined to the inferior two-thirds of the petrous apex. After mobilization, the resection was extended superiorly through the upper extent of the petrous apex.CONCLUSIONSThe transpterygoid corridor to the petroclival region is maximally expanded by the resection of the cartilaginous ET and mobilization of the paraclival ICA. These added maneuvers expanded the deep window almost 6 times and provided more lateral access to the petroclival region with a maximum volume of 1.5 cm3. This may result in the ability to resect small-to-moderate sized intradural petroclival lesions up to that volume. Larger lesions may better be approached through an open transcranial approach.

scholarly journals Surgical anatomy of the superior hypophyseal artery and its relevance for endoscopic endonasal surgery

2019 ◽  
Vol 131 (1) ◽  
pp. 154-162 ◽  
Author(s):  
Huy Q. Truong ◽  
Edinson Najera ◽  
Robert Zanabria-Ortiz ◽  
Emrah Celtikci ◽  
Xicai Sun ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Optic Chiasm ◽  
Surgical Anatomy ◽  
Endoscopic Endonasal ◽  
Suprasellar Region ◽  
Branching Patterns ◽  
Unilateral Injury ◽  
Two Sides ◽  
Internal Carotid Arteries ◽  
Vascular Injection

OBJECTIVEThe endoscopic endonasal approach has become a routine corridor to the suprasellar region. The superior hypophyseal arteries (SHAs) are intimately related to lesions in the suprasellar space, such as craniopharyngiomas and meningiomas. Here the authors investigate the surgical anatomy and variations of the SHA from the endoscopic endonasal perspective.METHODSThirty anatomical specimens with vascular injection were used for endoscopic endonasal dissection. The number of SHAs and their origin, course, branching, anastomoses, and areas of supply were collected and analyzed.RESULTSA total of 110 SHAs arising from 60 internal carotid arteries (ICAs), or 1.83 SHAs per ICA (range 0–3), were found. The most proximal SHA always ran in the preinfundibular space and provided the major blood supply to the infundibulum, optic chiasm, and proximal optic nerve; it was defined as the primary SHA (pSHA). The more distal SHA(s), present in 78.3% of sides, ran in the retroinfundibular space and supplied the stalk and may also supply the tuber cinereum and optic tracts. In the two sides (3.3%) in which no SHA was present, the territory was covered by a pair of infundibular arteries originating from the posterior communicating artery. Two-thirds of the pSHAs originated proximal to the distal dural ring; half of these arose from the carotid cave portion of the ICA, whereas the other half originated proximal to the cave. Four branching patterns of the pSHA were recognized, with the most common pattern (41.7%) consisting of three or more branches with a tree-like pattern. Descending branches were absent in 25% of cases. Preinfundibular anastomoses between pSHAs were found in all specimens. Anastomoses between the pSHA and the secondary SHA (sSHA) or the infundibular arteries were found in 75% cases.CONCLUSIONSThe first SHA almost always supplies the infundibulum, optic chiasm, and proximal optic nerve and represents the pSHA. Compromising this artery can cause a visual deficit. Unilateral injury to the pSHA is less likely to cause an endocrine deficit given the artery’s abundant anastomoses. A detailed understanding of the surgical anatomy of the SHA and its many variations may help surgeons when approaching challenging lesions in the suprasellar region.

Endoscopic Endonasal Anatomical Study of the Cavernous Sinus Segment of the Ophthalmic Nerve

2015 ◽  
Vol 76 (S 01) ◽  
Author(s):  
Ricardo Dolci ◽  
Ricardo Carrau ◽  
Lamia Buohliqah ◽  
Leo Filho ◽  
Mateo Zoli ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Anatomical Study ◽  
Endoscopic Endonasal

Fibrinolytic Activity of the Arterial Wall

1969 ◽  
Vol 21 (01) ◽  
pp. 001-011 ◽  
Author(s):  
K Onoyama ◽  
K Tanaka
Keyword(s):  
Carotid Artery ◽  
Fibrinolytic Activity ◽  
Arterial Wall ◽  
Aortic Wall ◽  
Internal Carotid ◽  
Atheromatous Plaque ◽  
Human Fibrinogen ◽  
The Media ◽  
The Common ◽  
Almost All

SummaryThe tissue fibrinolysis was studied in 550 specimens of 7 kinds of arteries from 80 fresh cadavers, using Astrup’s biochemical method and Todd’s histochemical method with human fibrinogen.In the microscopically normal aortic wall, almost all specimens had the fibrinolytic activity which was the strongest in the adventitia and the weakest in the media.The fibrinolytic activity seemed to be localized in the endothelium.The stronger activity lay in the adventitia of the aorta and the pulmonary artery and all layers of the cerebral artery.The activity of the intima and media of the macroscopically normal areas seemed to be stronger in the internal carotid artery than in the common carotid artery.Mean fibrinolytic activity of the macroscopically normal areas seemed to decrease with age in the intima and the media of the thoracic aorta and seemed to be low in the cases with a high atherosclerotic index.The fibrinolytic activities of all three layers of the fibrous thickened aorta seemed to decrease, and those of the media and the adventitia of the atheromatous plaque to increase.The fibrinolytic activity of the arterial wall might play some role in the progress of atherosclerosis.

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