Segments of the internal carotid artery during endoscopic transnasal and open cranial approaches: can a uniform nomenclature apply to both?
| Autor: | James L. Leach, Sébastien Froelich, Lee A. Zimmer, John J. DePowell, Philip V. Theodosopoulos, Alexandre Karkas, Jeffrey T. Keller |
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| Rok vydání: | 2013 |
| Předmět: |
business.industry
medicine.medical_treatment Endoscopic surgery Endoscopy Anatomy Neurosurgical Procedures Computed tomographic Skull Dissection medicine.anatomical_structure medicine.artery Terminology as Topic medicine Cadaver Surgery Neurology (clinical) Posterior communicating artery Internal carotid artery Nasal Cavity Cadaveric spasm business Craniotomy Carotid Artery Internal |
| Zdroj: | World neurosurgery. 82 |
| ISSN: | 1878-8769 |
| Popis: | Background The classic anatomic view of the course of the internal carotid artery (ICA) and its segments familiar to neurosurgeons by a 3-dimensional microscopic cranial view may be challenging to understand when seen in the unique 2-dimensional view of transnasal endoscopic surgery. Objective We re-examined our 1996 classification of 7 (C1−C7) segments of the ICA, comparing the arterial course in cadaveric dissections for both a transnasal endoscopic transpenoidal approach and frontotemporal craniotomy. Methods Five formalin-fixed cadaveric heads injected with colored silicone underwent thin-cut computed tomographic scanning for bony and vascular analysis. The ICA's intracranial course viewed by transnasal endoscopic dissection was compared with the view of a bilateral frontotemporal crantiotomy, from the petrous (C2) to communicating (C7) segments. Results Refinement of our 1996 ICA classification provides an anatomical understanding for endoscopic exposures transnasally along an inferior skull base trajectory. The changing course of the ICA, initially termed loop is now termed bend (i.e., implying a change in direction). Four bends are described as the ICA enters into the skull base as C2, C3−C4, C4, and C4−C5. We discuss delineation of certain problematic ICA segments and identify landmarks for endoscopic endonasal approaches. Conclusions Our classification of the segments of the ICA achieves consistency without sacrificing either clinical or anatomic accuracy for either transcranial or endoscopic approaches. Universal application of this established nomenclature can avoid new and misleading terms, respects anatomical landmarks delineating segments, and provides a universal language for clear communication between disciplines. |
| Databáze: | OpenAIRE |
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