Microsurgical Anatomy of the Dural Collar (Carotid Collar) and Rings around the Clinoid Segment of the Internal Carotid Artery

Abstract The perforating branches of the internal carotid artery (ICA) were examined in 30 forebrain hemispheres. These branches were present in all the cases studied, and varied from 1 to 6 in number (mean, 3.1). Their diameters ranged from 70 to 470 Mm (mean, 243 Mm). The perforating branches arose from the choroidal segment of the ICA, that is, from its caudal surface (52.3%), caudolateral surface (34.1%), or caudomedial surface (13.6%). They rarely originated from the bifurcation point of the ICA (10%). The distance of the remaining 90% of the perforators from the summit of the ICA measured between 0.6 and 4.6 mm. The perforating branches most often originated as individual vessels, and less frequently from a common stem with another vessel or by sharing the same origin site with another perforator or with the anterior choroidal artery. The bifurcation of the ICA, which is a frequent site for cerebral aneurysms, is surrounded by many perforating branches. Hence, great care must be taken to avoid damage to these important vessels during operations in that region.

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Microsurgical Anatomy of the Endoscopy-Assisted Retrosigmoid Intradural Suprameatal Approach to the Meckel's Cave

Operative Neurosurgery ◽

10.1093/ons/opab096 ◽

2021 ◽

Author(s):

Yuanzhi Xu ◽

Benjamin K Hendricks ◽

Maximiliano Alberto Nunez ◽

Ahmed Mohyeldin ◽

Juan C Fernandez-Miranda ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Internal Auditory Canal ◽

Semicircular Canals ◽

Petrous Apex ◽

Microsurgical Anatomy ◽

Meckel’S Cave ◽

Meckel's Cave ◽

Trigeminal Root

Abstract BACKGROUND Understanding the microsurgical anatomical features of the endoscopy-assisted retrosigmoid intradural suprameatal approach (RISA) is critical for surgeons treating petroclival tumors or lesions in the cerebellopontine region that extend into Meckel's cave. OBJECTIVE To evaluate increased exposure for Meckel's cave in the RISA and assess the surgical landmarks for this approach. METHODS A standard retrosigmoid craniotomy to the cerebellopontine region was performed in 4 cadaveric specimens (8 hemispheres) with microscope-assisted endoscopy. The length and depth of the drilling region from the suprameatal tubercle to the petrous apex were analyzed. After opening Meckel's cave and mobilizing the trigeminal root completely, the landmarks for this approach were investigated. RESULTS The endoscopy-assisted RISA facilitates mobilization of the trigeminal root and enhances surgical exposure in the region of Meckel's cave and the petrous apex with increases of 10.1 ± 1.3 mm in depth, 21.4 ± 3.2 mm in length, and 6.4 ± 0.6 mm in height. The posterior and superior semicircular canals, internal auditory canal, superior petrous sinus, and internal carotid artery (petrous segment) served as important landmarks for this approach. One case illustration is presented to describe the application of this approach. CONCLUSION The RISA is suitable mainly for lesions in the posterior fossa that extend into Meckel's cave. The endoscopy-assisted reach optimizes accessibility to the petrous apex region, obviates the need for extensive drilling, and decreases the risk of internal carotid artery injury. Better realization and recognition of microsurgical landmarks and parameters of this approach are crucial for successful outcomes.

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Microsurgical anatomy of the internal carotid artery at the skull base

The Journal of Laryngology & Otology ◽

10.1017/s0022215121003406 ◽

2021 ◽

pp. 1-10

Author(s):

K C Prasad ◽

A Gupta ◽

G Induvarsha ◽

P K Anjali ◽

V Vyshnavi

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Skull Base ◽

Internal Carotid ◽

Microsurgical Anatomy

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Microsurgical Anatomy and Surgical Exposure of the Petrous Segment of the Internal Carotid Artery

Operative Neurosurgery ◽

10.1227/01.neu.0000327037.75571.10 ◽

2008 ◽

Vol 63 (suppl_4) ◽

pp. ONS210-ONS239 ◽

Cited By ~ 14

Author(s):

Shigeyuki Osawa ◽

Albert L. Rhoton ◽

Necmettin Tanriover ◽

Satoru Shimizu ◽

Kiyotaka Fujii

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Sphenoid Sinus ◽

Internal Carotid ◽

Lateral Wall ◽

Common Trunk ◽

Microsurgical Anatomy ◽

Carotid Canal ◽

Complex Relationships ◽

Arteries And Veins

Abstract Objective: The petrous segment of the internal carotid artery has been exposed in the transpetrosal, subtemporal, infratemporal, transnasal, transmaxillary, transfacial, and a variety of transcranial approaches. The objective of the current study was to examine anatomic features of the petrous carotid and its branches as related to the variety of approaches currently being used for its exposure. Methods: Twenty middle fossae from adult cadaveric specimens were examined using magnification of ×3 to ×40 after injection of the arteries and veins with colored silicone. Results: The petrous carotid extends from the entrance into the carotid canal of the petrous part of the temporal bone to its termination at the level of the petrolingual ligament laterally and the lateral wall of the sphenoid sinus medially. The petrous carotid from caudal to rostral was divided into 5 segments: posterior vertical, posterior genu, horizontal, anterior genu, and anterior vertical. Fourteen (70%) of the 20 petrous carotids had branches. The branch that arose from the petrous carotid was either a vidian or periosteal artery or a common trunk that gave rise to both a vidian and 1 or more periosteal arteries. The most frequent branch was a periosteal artery. Conclusion: An understanding of the complex relationships of the petrous carotid provides the basis for surgically accessing any 1 or more of its 5 segments.

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Taming the Cavernous Sinus: Technique of Hemostasis Using Fibrin Glue

Operative Neurosurgery ◽

10.1227/01.neu.0000289712.72555.9c ◽

2007 ◽

Vol 61 (suppl_3) ◽

pp. ONS-E52-ONS-E52 ◽

Cited By ~ 8

Author(s):

Niklaus Krayenbühl ◽

Ahmad Hafez ◽

Juha A. Hernesniemi ◽

Ali F. Krisht

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Fibrin Glue ◽

Cavernous Sinus ◽

Internal Carotid ◽

Cranial Base ◽

Sinus Surgery ◽

Microsurgical Anatomy ◽

Glue Injection

Abstract Objective: Improved understanding of the microsurgical anatomy of the cranial base region has made surgery in and through the cavernous sinus safer. However, continuous venous oozing that occurs during cavernous sinus surgery can cause significant blood loss and poor visualization. We describe a technique that will help minimize cavernous sinus bleeding and improve the safety of the surgical steps. Methods: The lateral wall of the cavernous sinus is exposed. Cavernous sinus access windows between the V1 and V2 branches of the trigeminal nerve and posterior to the clinoidal internal carotid artery are used to inject fibrin glue into the different cavernous sinus compartments. Postoperative follow-up cerebral angiography in basilar apex aneurysms clipped using the transcavernous approach were evaluated for cavernous sinus patency during the venous phase. Results: Fibrin glue injection between V1 and V2 obliterated the lateral cavernous sinus compartment. Fibrin glue injection posterior to the clinoidal segment of the internal carotid artery obliterated the medial compartment of the cavernous sinus. These steps were used in 217 surgical procedures (95 benign and 9 malignant neoplastic lesions; 113 aneurysms). There were no significant clinical side effects. Follow-up angiographic controls of basilar aneurysms operated on via the transcavernous approach consistently showed the reestablishment of flow within the cavernous sinus as early as 2 to 3 months postoperatively. Conclusion: Presently, the use of hemostatic agents and the better understanding of the microsurgical anatomy of the cranial base and cavernous sinus enable us to tame the cavernous sinus and operate in and around it with a high degree of safety.

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Microsurgical anatomy of the arterial compartment of the cavernous sinus: analysis of 24 cavernous sinus

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2005000200012 ◽

2005 ◽

Vol 63 (2a) ◽

pp. 259-264 ◽

Cited By ~ 11

Author(s):

Gustavo Isolan ◽

Evandro de Oliveira ◽

João Paulo Mattos

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Cavernous Sinus ◽

Internal Carotid ◽

Sella Turcica ◽

Microsurgical Anatomy ◽

Isolated Artery ◽

Anatomy Knowledge ◽

Tentorial Artery ◽

Meningohypophyseal Trunk

The cavernous sinus is a complex compartment situated in both sides of the sella turcica, being its microsurgical anatomy knowledge of fundamental importance when consider to approach surgically. We studied the arterial microanatomy of 24 cavernous sinus at the microsurgical laboratory, considering that in all the internal carotid artery were filled with colored latex. The meningohypophyseal trunk was present in 18 cases (75%) with its origin in intracavernous portion of the internal carotid artery. In relation to the 18 presented cases with meningohypophyseal trunk, 14 (77.7%) had a trifurcate and 4 (23.3%) had a bifurcate pattern. The tentorial artery was present in all. Its origin was observed, arising from the meningohypophyseal trunk in 17 (70.8%) and as an isolated artery in some extension of the intracavernous portion in 7 (29.1%). An accessory tentorial artery was found in one specimen. The dorsal meningeal artery was present in 22 cases (91.6%). Its origin was in the meningohypophyseal trunk in 17 cases (77.2%), arising from internal carotid artery in 4 cases (18.1%) and from inferior hypophyseal artery in one case (4.1%).The inferior hypophyseal artery was present in all cases, having its origin at the meningohypophyseal trunk in 16 cases (66.6%). In the remaining 8 cases (33.3%) the artery was found arising alone from the intracavernous portion also. The artery of the inferior cavernous sinus or inferolateral trunk was present in all cases and had its origin from internal carotid artery in its intracavernous segment. The McConnell's artery was not found in any cavernous sinus.

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