scholarly journals Gross and Micro-Anatomical Study of the Cavernous Segment of the Abducens Nerve and Its Relationships to Internal Carotid Plexus: Application to Skull Base Surgery

2021 ◽  
Vol 11 (5) ◽  
pp. 649
Author(s):  
Grzegorz Wysiadecki ◽  
Maciej Radek ◽  
R. Shane Tubbs ◽  
Joe Iwanaga ◽  
Jerzy Walocha ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid ◽  
Skull Base Surgery ◽  
Anatomical Study ◽  
Abducens Nerve ◽  
Lateral Wall ◽  
Anatomical Variations ◽  
Primary Site ◽  
Vertical Segment ◽  
Single Nerve

The present study aims to provide detailed observations on the cavernous segment of the abducens nerve (AN), emphasizing anatomical variations and the relationships between the nerve and the internal carotid plexus. A total of 60 sides underwent gross-anatomical study. Five specimens of the AN were stained using Sihler’s method. An additional five specimens were subjected to histological examination. Four types of AN course were observed: a single nerve along its entire course, duplication of the nerve, division into separate rootlets at the point of contact with the cavernous part of the internal carotid artery (ICA), and early-branching before entering the orbit. Due to the relationships between the ICA and internal carotid plexus, the cavernous segment of the AN can be subdivided into a carotid portion located at the point of contact with the posterior vertical segment of the cavernous ICA and a prefissural portion. The carotid portion of the cavernous AN segment is a place of angulation, where the nerve always directly adheres to the ICA. The prefissural portion of the AN, in turn, is the primary site of fiber exchange between the internal carotid plexus and either the AN or the lateral wall of the cavernous sinus.

Meningovenous Structures of the Petroclival Region: Clinical Importance for Surgery and Intravascular Surgery

Neurosurgery ◽  
2002 ◽  
Vol 50 (4) ◽  
pp. 829-837 ◽  
Author(s):  
Mehmet Faik Ozveren ◽  
Koichi Uchida ◽  
Sadakazu Aiso ◽  
Takeshi Kawase
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Nerve Injury ◽  
Internal Carotid ◽  
Abducens Nerve ◽  
Lateral Wall ◽  
Petrous Apex ◽  
Anatomic Variations ◽  
Arachnoid Membrane ◽  
Petroclival Region

Abstract OBJECTIVE: The goals of this investigation were to perform a detailed analysis of petroclival microanatomic features, to investigate the course of the abducens nerve in the petroclival region, and to identify potential causes of injury to neurovascular structures when anterior transpetrosal or transvenous endovascular approaches are used to treat pathological lesions in the petroclival region. METHODS: Petroclival microanatomic features were studied bilaterally in seven cadaveric head specimens, which were injected with colored silicone before microdissection. Another cadaveric head was used for histological section analyses. RESULTS: A lateral or medial location of the abducens nerve dural entrance porus, relative to the midline, was correlated with the course and angulation of the abducens nerve in the petroclival region. The angulation of the abducens nerve was greater and the nerve was closer to the petrous ridge in the lateral type, compared with the medial type. The abducens nerve exhibited three changes in direction, which represented the angulations in the petroclival region, at the dural entrance porus, the petrous apex, and the lateral wall of the internal carotid artery. The abducens nerve was covered by the dural sleeve and the arachnoid membrane, which became attenuated between the second and third angulation points. The abducens nerve was anastomosed with the sympathetic plexus and fixed by connective tissue extensions to the lateral wall of the internal carotid artery and the medial wall of Meckel's cave at the third angulation point. There were two types of trabeculations inside the sinuses around the petroclival region (tough and delicate). CONCLUSION: The petroclival part of the abducens nerve was protected in a dural sleeve accompanied by the arachnoid membrane. Therefore, the risk of abducens nerve injury during petrous apex resection via the anterior transpetrosal approach, with the use of the transvenous route through the inferior petrosal sinus to the cavernous sinus, should be lower than expected. The presence of two anatomic variations in the course of the abducens nerve, in addition to findings regarding nerve angulation and tethering points, may explain the relationships between adjacent structures and the susceptibility to nerve injury with either surgical or endovascular approaches. Venous anatomic variations may account for previously reported cases of subarachnoid hemorrhage with the endovascular approach.

Eustachian tube and internal carotid artery in skull base surgery: An anatomical study

2014 ◽  
Vol 124 (12) ◽  
pp. 2655-2664 ◽  
Author(s):  
Jianfeng Liu ◽  
Carlos D. Pinheiro-Neto ◽  
Juan C. Fernandez-Miranda ◽  
Carl H. Snyderman ◽  
Paul A. Gardner ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Eustachian Tube ◽  
Internal Carotid ◽  
Skull Base Surgery ◽  
Anatomical Study

scholarly journals Anatomy of the Middle Cerebral Artery and some related arteries on 256 MSCT

2019 ◽  
Vol 35 (2) ◽  
Author(s):  
Nguyen Tuan Son ◽  
Ngo Xuan Khoa ◽  
Nguyen Quoc Dung ◽  
Dao Dinh Thi
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Anatomical Study ◽  
Anatomical Variations ◽  
Anterior Communicating Artery ◽  
Microsurgical Anatomy ◽  
Medical University

Abstracts: Introduction: studying the percentage of display and dimensions of the middle cerebral artery and some related arteries on on  256 MSCT data. Methods: A cross-sectional study, with sample size of 261. Results: The percentage of display of middle cerebral artery is 100%; the posterior artery is 76.4; Internal Carotid Artery is 100%. The average diameter, average length are (mm) M1T respectively: 3.25 ± 0.43 and 19.98 ± 6.10; M1 P: 3.26 ± 0.46 and 19.68 ± 6.28; M2T left 2.10 ± 0.48 and 22.85 ± 13.18; M2T right 2.09 ± 0.49 and 23.42 ± 11.89; M2D left 2.48 ± 0.49 and 31.73-16.36; M2D  right 2.55 ± 0.49 and 29.11 ± 15.31. PCoA T 1.29 ± 0.63 and 11.87 ± 4.87; PCoA P 1.26 ± 0.66 and 14.02 ± 9.13; Conclusions: The size of the middle cerebral artery and some related  arteries were accurately evaluated in the study, the image of vascular anatomy was display clearly. Keywords Middle cerebral artery, cerebral angiography, multi-slices computed tomography ... References [1] H.V. Cúc. To the study of arterial blood supply vessels for Vietnamese adults, Ministry of Health research project, Hanoi Medical University, Hanoi, Vietnam (2000) (in Vietnamese).[2] H.M.Tú. To the study of cerebral artery anatomy on MSCT 64 image, Master's thesis in Medicine, Hanoi Medical University, Hanoi, Vietnam (2011) (in Vietnamese).[3] Ogeng'o, J.A. Geometric features of Vertebrobasilar arterial system in adult Black Kenyans, Int. J. Morphol, 36(2) (2018) 544 - 50. [4] KrzyżewsKi, R.M.. Variation of the anterior communicating artery complex and occurrence of anterior communicating artery aneurysm: A2 segment consideration, Folia medica cracoviensia, LIV (1) (2014) 13 - 20.[5] Jiménez-Sosa, M.S. Anatomical variants of Anterior cerebral arterial circle. A study by Multidetector computerized 3D tomographic angiography, Int J. Morphol 35(3) 1121 – 28.[6] Hamidi, C. (2013). Display with 64-detector MDCT angiography of cerebral vascular variations, Surg Radiol Anat 35 (2017) 729 – 36.[7] Dimmick, S.J., et al. Normal variations of the cerebral circulation at multidetector CT angiography, Radiographics 29(4) (2009) 1027 – 43.[8] P.T.Hà. To the study of Willis polygonal anatomy on MSCT 128 image of patients with cerebral aneurysm, Specialish level 2 thesis in Hanoi Medical University, Hanoi, Vietnam.[9] Saha, A. (2013). Variation of posterior communicating artery in human brain: a morphological study, Gomal Journal of Medical Sciences 11(1) (2018). 42 – 6.[10] Gullari, G. K. The branching pattern of the middle cerebral artery: is the intermediate trunk real or not? An anatomical study correlating with simple angiography, J.Neurosurg, 116 (2012) 1024 - 34.[11] Canaz, H., el al Morphometric analysis of the arteries of Willis Polygon, Romanian Neurosurgery, XXXII (1) (2018) 56 - 64.[12] Pedroza, A. (1987). Microanatomy of the Posterior Communicating Artery, Neurosurgery 20(2) (2018) 229 – 35.[13] Keeranghat, P. P., et al. Evaluation of normal variants of circle of Willis at MRI, Int.J. Res Med Sci, 6(5) (2018) 1617 - 22.[14] Tao, X., Yu, et al. Microsurgical anatomy of the anterior communicating artery complex in adult Chinese heads, Surgical Neurology 65 (2006) 155 – 61.[15] Krejza, J., et al. Carotid artery diameter in Men and Women and the relation to body and neck size, Stroke, 37 (2006) 1103 - 5.[16] Masatoukawashima. Microsurgical anatomy of cerebral revascularization. Part I: Anterior circulation, J.Neurosurg, 102 (2005) 116 – 31.[17] Jeyakumar.R., et al, Study of Anatomical Variations in Middle Cerebral Artery, Int.J.Sci Stud 5(12) (2018) 5-10. [18] Brzegowy, P, et al Middle cerebral artery anatomical variations and aneurysms: a retrospective study based on computed tomography angiography findings, Folia Morphol, 77(3) (2018) 434 – 40.[19] Rohan, V., et al, Length of Occlusion predicts recanalization and outcome after intravenous thrombolysis in middle cerebral artery stroke, Stroke, 45 (2014) 2010 - 17.[20] Vijaywargiya, M., et al. Anatomical study of petrous and cavernous parts of internal carotid artery, Anat Cell Biol, 50 (2017) 163 - 70.[21] Bouthillier, et al Segments of the internal carotid artery: a new classification, Neurosurgery, 38(3), (1996) 425 - 32.  

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

2020 ◽  
Vol 133 (5) ◽  
pp. 1382-1387 ◽  
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.

Extracranial internal carotid artery: anatomical variations in asymptomatic patients

2016 ◽  
Vol 38 (8) ◽  
pp. 893-902 ◽  
Author(s):  
Salvatore Cappabianca ◽  
Francesco Somma ◽  
Alberto Negro ◽  
Michele Rotondo ◽  
Assunta Scuotto ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Anatomical Variations ◽  
Extracranial Internal Carotid Artery ◽  
Asymptomatic Patients

scholarly journals Surgical considerations about the anterior syphon knee of the internal carotid artery

1995 ◽  
Vol 53 (1) ◽  
pp. 34-37 ◽  
Author(s):  
Murilo S. Meneses ◽  
Danielle Molinari ◽  
Marcia Fortes ◽  
Patricia Rangel ◽  
Tatiana Neves ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Anatomical Study ◽  
Vascular Lesions ◽  
Intracavernous Carotid Artery ◽  
Microsurgical Approach ◽  
Microsurgical Techniques ◽  
Anatomical Finding ◽  
Anterior Knee

An anatomical study about the anterior knee of the intracavernous carotid artery is presented. Twenty cavernous sinuses (CS) were dissected in cadavers using microsurgical techniques. A fibrous ring around the internal carotid artery (ICA) at the CS roof was found in all specimens. This fibrous attachment could be dissected from the surrounding dura and a loose connective tissue could be demonstrated around the ICA. This anatomical finding makes possible the microsurgical approach to vascular lesions of this portion of the ICA, without opening the cavernous sinus.

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