Internal Carotid Artery in the Operative Plane of Endoscopic Endonasal Transsphenoidal Surgery

Abstract

The objective of this study was to measure the related parameters of intercarotid artery (ICA) in the operative plane of endonasal transsphenoidal approach for hypophyseal surgeries. Nine parameters of the ICA were examined in the computed tomographic angiographic (CTA) scan of 101 patients. The shortest distance between the middle point of the nasal columella and the projective point of the ICA (D(3)) was 85.50 (5.79) mm. The shortest distance between the anterior wall of the sphenoid sinus and the projective point of the ICA (D(4)) was 16.93 (3.50) mm. The distance between the bilateral projective points of the ICA (D(5)) was 21.60 (3.45) mm. The shortest distance from the anterior wall of the sphenoid sinus to the line between the bilateral projective points of the ICA (D(6)) was 12.1 (3.91) mm. The shortest distance between the middle point of nasal columella and the anterior wall of the sphenoid sinus (D(7)) was 72.67 (5.99) mm. The width of the angle between the bilateral ICA projective point from the middle point of the nasal columella (A(1)) was 14.9 (2.32) degrees. The width of the angle between the bilateral ICA projective points from the anterior-most point of sphenoid sinus (A(2)) was 85.49 (18.12) degrees. Clinically, it is relatively safe to work within the distances and angles measured in this research, and these results may provide information for clinical surgery of pituitary tumor.

Pituitary macroadenoma: analysis of intercarotid artery distance compared to controls

“…Different methods of measuring the intercarotid distance have been used in the literature 1,2,6,17,22,23 , among them, the T1W gadolinium enhanced MRI. Although it was not a primary objective in our study, we could conclude that the intercarotid distance measurement using enhanced-MRI is a reproducible method to evaluate the intercarotid distance, with excellent inter-observer correlation (ICC = 0,93 for ICD1; ICC = 0,91 for ICD2).…”

“…In the transsphenoidal approach for pituitary adenomas, detailed preoperative planning with information regarding the sphenoid sinus, tumoral involvement of adjacent structures (cavernous sinus, suprasellar region, carotid arteries) and intercarotid distance (ICD) is critical. Despite that, there is little literature regarding the ICD at the parassellar region of the intracranial carotid arteries at its cavernous segment and its modifications due to the sellar pathologies, specially non-functioning pituitary adenomas 2,3,4,5,6 .Although vascular injuries have become less frequent over the years, with reports ranging from 0-3.8% 7,8,9,10,11,12,13,14,15,16,17,18,19,20 , it is still considered one of the most important complications in the transsphenoidal approaches due to its potential hazardous effects and difficult management. Taking this into consideration, it is crucial that every surgeon knows exactly the carotid artery position and its relation to the lesion.…”

“…Although vascular injuries have become less frequent over the years, with reports ranging from 0-3.8% 7,8,9,10,11,12,13,14,15,16,17,18,19,20 , it is still considered one of the most important complications in the transsphenoidal approaches due to its potential hazardous effects and difficult management. Taking this into consideration, it is crucial that every surgeon knows exactly the carotid artery position and its relation to the lesion.…”

Quantitative analysis of anatomical relationship between cavernous segment internal carotid artery and pituitary macroadenoma

“…[ 15 , 16 ] Although quantitative analysis of distances between CSICAs while facing endoscopic transsphenoidal approaches were conducted, these studies failed to discuss the direct association between CSICA morphology and pituitary adenoma. [ 4 , 5 , 11 , 15 – 19 ] Measurements from cadaveric study and those from image study existed significant difference. [ 16 ]…”

Radiological “Teddy Bear” Sign on CT Imaging to Aid Internal Carotid Artery Localization in Transsphenoidal Pituitary and Anterior Skull Base Surgery

“…Several studies in the literature have correlated cadaveric and imaging findings to identify bony landmarks and the normal course of the ICA during endoscopic transsphenoidal surgery; [17][18][19][20] nevertheless, work describing the anatomical relationship between the parasellar ICA and pituitary illustrates the enormous variation in anatomy between the patients. [21][22][23] An attempt to establish a formalized approach for facilitating safe transsphenoidal pituitary surgery by way of a radiological anatomical landmark checklist has been presented introducing the radiological "teddy bear" sign.…”