Exposure of the Distal Cervical Segment of the Internal Carotid Artery Using the Trans-spinosum Corridor: Cadaveric Study of Surgical Anatomy

2008 ◽  
Vol 62 (suppl_5) ◽  
pp. ONS354-ONS362 ◽  
Author(s):  
Sebastien C. Froelich ◽  
Khaled M. Abdel Aziz ◽  
Nicholas B. Levine ◽  
Myles L. Pensak ◽  
Philip V. Theodosopoulos ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Facial Nerve ◽  
Temporomandibular Joint ◽  
Internal Carotid ◽  
Cranial Base ◽  
Distal Portion ◽  
Carotid Sheath ◽  
Orbitozygomatic Approach ◽  
Cervical Segment

Abstract Background: Exposure of the most distal portion of the cervical segment of the internal carotid artery (ICA) is technically challenging. Previous descriptions of cranial base approaches to expose this segment noted facial nerve manipulation, resection of the glenoid fossa, and significant retraction or resection of the condyle. We propose a new approach using the frontotemporal orbitozygomatic approach to expose the distal portion of the cervical segment of the ICA via the trans-spinosum corridor. Methods: Six formalin-fixed injected heads were used for cadaveric dissection. Two blocs containing the carotid canal and surrounding region were used for histological examination. Results: The ICA lies immediately medial to the vaginal process. The carotid sheath attaches laterally to the vaginal process. With use of the trans-spinosum corridor, the surgeon's line of sight courses in front of the temporomandibular joint, through the foramen spinosum, spine of the sphenoid, and vaginal process. Removal of the vaginal process exposes the vertical portion of the petrous segment of the ICA. The loose connective tissue space between the adventitia and the carotid sheath is easily entered from above. Incision of the carotid sheath exposes the ICA without disruption of the temporomandibular joint. Conclusion: Control of the cervical segment of the ICA can be critical when dealing with cranial base tumors that invade or surround the petrous segment of the ICA. This novel technique through the trans-spinosum corridor can effectively expose the distal portion of the cervical segment of the ICA without causing manipulation of the facial nerve and while maintaining the integrity of the temporomandibular joint.

Internal Carotid Artery Dissection: A Rare Cause of Peripheral Facial Nerve Palsy

2012 ◽  
Vol 68 (2) ◽  
pp. 74-74 ◽  
Author(s):  
Valentina Fioravanti ◽  
Giulia Vinceti ◽  
Annalisa Chiari ◽  
Elena Canali ◽  
Paolo Frigio Nichelli ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Facial Nerve ◽  
Nerve Palsy ◽  
Internal Carotid ◽  
Facial Nerve Palsy ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Internal Carotid Artery Dissection ◽  
Peripheral Facial Nerve Palsy

Operative Exposure and Management of the Petrous and Upper Cervical Internal Carotid Artery

Neurosurgery ◽  
1986 ◽  
Vol 19 (6) ◽  
pp. 967-982 ◽  
Author(s):  
Laligam N. Sekhar ◽  
Victor L. Schramm ◽  
Neil F. Jones ◽  
Howard Yonas ◽  
Joseph Horton ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Wound Infection ◽  
Internal Carotid ◽  
Arterial Occlusion ◽  
Cranial Base ◽  
Balloon Occlusion ◽  
Malignant Neoplasms ◽  
Upper Cervical ◽  
Cervical Internal Carotid Artery

Abstract The exposure and operative management of the petrous and upper cervical internal carotid artery (ICA) in 29 patients is detailed. Twenty-seven of these patients had extensive cranial base neoplasms (benign or malignant), 1 had an inflammatory cholesteatoma, and 1 had an aneurysm of the upper cervical ICA immediately proximal to the carotid canal. Preoperative studies useful in the evaluation of these patients included computed tomography, magnetic resonance imaging, cerebral and cervical angiography, and a balloon occlusion test of the ICA with evaluation of neurological status and of cerebral blood flow. The exposure of the upper cervical and petrous ICA was useful to obtain proximal control of the cavernous ICA, aided in the operative approach to extensive petroclival, intracavernous, and parapharyngeal neoplasms, and enabled the total resection of 23 of 27 such tumors. A subtemporal and preauricular infratemporal fossa approach was most commonly used for the exposure of the artery. Intraoperative arterial management consisted of exposure and decompression only, dissection from encasing neoplasm, resection of the invaded arterial segment and vein graft reconstruction, or intentional arterial occlusion. Vascular complications included 1 stroke due to delayed arterial occlusion, 1 stroke and death due to infection spreading from the nasopharynx with bilateral ICA rupture, and 1 pseudoaneurysm formation secondary to wound infection necessitating postoperative balloon occlusion of the ICA. Nonvascular complications included facial nerve paralysis in 10 patients (usually temporary), glossopharyngeal and vagal paralysis in 13 patients requiring Teflon injection of the vocal cord in 9, temporary difficulties with mastication in 9 patients, and wound infection in 3. The surgical exposure and management of the upper cervical and petrous ICA may permit a total operative resection of extensive cranial base neoplasms and is also an alternative for the management of vascular lesions involving these segments of the artery. With malignant neoplasms extending from the nasopharynx, postoperative infection remains a problem and may best be resolved by the use of a vascularized rectus abdominis muscle flap to reconstruct defects of the nasopharynx. Bilateral ICA encasement by neoplasms is also a major problem to be solved. The value of such an aggressive approach to the management of malignant neoplasms remains to be proven.

Taming the Cavernous Sinus: Technique of Hemostasis Using Fibrin Glue

2007 ◽  
Vol 61 (suppl_3) ◽  
pp. ONS-E52-ONS-E52 ◽  
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.

scholarly journals Aberrant internal carotid artery presenting as a retrotympanic vascular mass

2014 ◽  
Vol 3 (10) ◽  
pp. 204798161455369 ◽  
Author(s):  
Simon Nicolay ◽  
Bert De Foer ◽  
Anja Bernaerts ◽  
Joost Van Dinther ◽  
Paul M Parizel
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Young Woman ◽  
Middle Ear ◽  
Internal Carotid ◽  
Preoperative Planning ◽  
Aberrant Internal Carotid Artery ◽  
Cervical Segment ◽  
Collateral Pathway ◽  
Vascular Variant

We report a case of a young woman with an aberrant right internal carotid artery (ICA) presenting as a retrotympanic reddish mass. This variant of the ICA represents the collateral pathway that is formed as a result of an embryological agenesis of the cervical segment of the ICA. The embryonic inferior tympanic artery is recruited to bypass the absent carotid segment. This hypertrophied vessel may be seen otoscopically and wrongfully considered to be a vascular middle ear tumor. Informing the otorhinolaryngologist of this important vascular variant not only obviates biopsy but also helps in careful preoperative planning of eventual middle ear procedures.

scholarly journals Simple aspiration with balloon catheter technique (simple ABC technique) against proximal internal carotid artery occlusion in cases of cardiogenic cerebral embolism

2018 ◽  
Vol 24 (3) ◽  
pp. 317-321 ◽  
Author(s):  
Akitake Okamura ◽  
Kazuhiko Kuroki ◽  
Katsuhiro Shinagawa ◽  
Naoto Yamada
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Internal Carotid ◽  
Balloon Catheter ◽  
Stent Retriever ◽  
Cervical Segment ◽  
Guiding Catheter

Background In cases of acute ischemic stroke, manual aspiration of the thrombus is commonly performed with a balloon guiding catheter placed in the cervical segment of the internal carotid artery (ICA). However, most manual aspirations using a balloon guiding catheter are combined with inner catheters, as in the direct aspiration first pass technique (ADAPT). We experienced some cases of acute ischemic stroke with proximal ICA occlusion due to cardiogenic thrombus where we obtained sufficient recanalization by simple manual aspiration from inflated Optimo 9F balloon catheters (Tokai Medical Products, Japan) placed in the origin of the cervical segment of the ICA without any inner catheter or stent retriever. We perform by preference this procedure, named the simple Aspiration with Balloon Catheter (simple ABC) technique. Herein, we report two recent cases and discuss this procedure. Case presentation Case 1: An 80-year-old man with paroxysmal atrial fibrillation developed left ICA occlusion. We performed the simple ABC technique and obtained a large amount of dark red and white thrombus. Puncture-to-reperfusion time was 14 minutes with Thrombolysis in Cerebral Infarction (TICI) grade 3. Case 2: A 69-year-old man with chronic atrial fibrillation developed left internal carotid occlusion. We performed the simple ABC technique and obtained a large amount of dark red thrombus. Puncture-to-reperfusion time was 15 minutes with TICI grade 2b. Conclusion The simple ABC technique is useful to deal with a large amount of thrombus, shortens procedure time, enables less invasive thrombectomy, and can shift immediately to subsequent procedures such as delivering a stent retriever or ADAPT.

The Supratubal Recess in Cholesteatoma Surgery

1986 ◽  
Vol 95 (1) ◽  
pp. 12-15 ◽  
Author(s):  
Karl L. Horn ◽  
William M. Luxford ◽  
Derald E. Brackmann ◽  
John J. Shea
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Facial Nerve ◽  
Internal Carotid ◽  
Three Dimensional ◽  
Middle Fossa ◽  
Canal Wall ◽  
Tegmen Tympani ◽  
Bony Ridge ◽  
Cholesteatoma Surgery

Acquired attic retraction cholesteatoma involving the anterior epitympanum is infrequently encountered and even less frequently discussed in the literature. The lack of cholesteatoma in this region is mostly due to a ridge of bone extending inferiorly from the tegmen tympani, just anterior to the cochleariform process. The term “cog” was coined and popularized to refer to this bony ridge. Erosion of the cog by cholesteatoma matrix allows extension of cholesteatoma into the supratubal recess. A number of vital structures including the facial nerve, cochlea, middle fossa dura, and internal carotid artery are intimately related to the supratubal recess. A clear three-dimensional understanding of these structures is necessary to remove disease safely from this area regardless of whether the posterior canal wall is left up or taken down. We present a series of dissection illustrations of the supratubal recess and discuss the possible routes of cholesteatoma extension. A series of patients with varying degrees of involvement of the supratubal recess and related structures is presented, and the pitfalls and management of cholesteatoma in this area are discussed.

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