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

Abstract

NA

Refining the anatomic boundaries of the endoscopic endonasal transpterygoid approach: the “VELPPHA area” concept

“…However, even if it is well accepted in the pertinent literature, care should be taken when dealing with the concept of "following the vidian nerve" and considering it the main anatomical landmark to check for petrous ICA position. [10][11][12]15 The so-called VELPPHA area (for vidian nerve, eustachian tube, foramen lacerum, petroclival fissure, and pharyngobasilar fascia) is a group of skull base fibrocartilaginous tissues that join together and represent an easy anatomical landmark at the posterior limits of the endonasal transpterygoid approach.…”

“…The technique herewith described includes drilling medially and inferiorly to the VC; afterwards dissection proceeds in a posterior direction until a fibrocartilaginous tissue is identified, which marks the attachment to the FL and the anterior border of the second genu of the ICA. 11,12,14 Moving in a medial to lateral direction along the anteroinferior border of the horizontal ICA, the anterior genu of the ICA can be exposed after removal of the cartilaginous ET. Recently Taniguchi et al 22 described the supra-eustachian triangle, a space bordered by the inferior aspect of the horizontal segment of the petrous ICA, by the superior aspect of the ET, and inferiorly by a vertical line along the medial aspect of the lacerum ICA.…”

“…Although the identification of the VN in the proximal aspect of its canal may permit us to safely identify the anterior genu of the ICA, the endoscopic anatomy of the most inferior and posterior area surrounding the ICA in this region-that is, the deepest and most posterior limit of the endoscopic endonasal transpterygoid route-has not been well documented. 11,12 Accordingly, the main goal of this study is to detail and quantify the anatomical relationship between the posterior end of the VN, the posterior end of the VC, and the neuro-fibrocartilaginous components of the FL and highlight how such peri-lacerum anatomy is crucial for safe endoscopic endonasal transpterygoid surgery.…”

The relationship between the carotid canal and mandibular condyle: an anatomical study with application to surgical approaches to the skull base via the infratemporal fossa

“…[9,24] In ITF approaches type B and type C, the main landmarks used during manipulation of the ICA are the basal turn of the cochlea, Eustachian tube, foramen spinosum, mandibular nerve and anterior foramen lacerum. [9,25] Talebzadeh et al [26] measured a transverse distance average of 37.5 mm from the carotid artery to the zygomatic arch. This ranged from 29 mm to 48 mm.…”

Surgical landmarks of the nasopharyngeal internal carotid using the maxillary swing approach: A cadaveric study

“…Although the intrapetrous, paraclival, and parasellar portions of the ICA have clear surgical landmarks due to their fixed position in the bony canals, the paranasopharyngeal portion, which is surrounded by soft tissue, does not have reliable surgical landmarks and is always hazardous to find. Several authors have studied the relationship between the ICA and the nasopharynx or between the external aperture of the carotid canal and the eustachian tube using an endoscopic or a lateral approach . Some imagery studies (computed tomography [CT] scan or magnetic resonance imaging based) have measured the distance in between the ICA and anatomical landmarks .…”