Micro-anatomical study of the carotid cave

Hitotsumatsu, Tsutomu; Natori, Yoshihiro; Matsushima, Toshio; Fukui, Masashi; Tateishi, Jun

doi:10.1007/bf01411405

Cited by 34 publications

(14 citation statements)

References 15 publications

(23 reference statements)

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“…26 The carotid cave has been identified in 68% to 95% of cases. 23,27,28 Mobilization of the outer dural layer of the roof of the cavernous sinus reveals the inner layer. The interclinoid ligament merges with the inner layer along its entire length, dividing the roof of the cavernous sinus into 2 triangular areas as a posterolaterally placed oculomotor trigone and an anteromedially placed carotid trigone.…”

Section: Dural Relationsmentioning

confidence: 99%

Aneurysms of the Ophthalmic (C6) Segment of the Internal Carotid Artery

Beretta¹,

Andaluz²,

Zuccarello³

et al. 2005

Neurosurgery Quarterly

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Aneurysms arising from the intradural ophthalmic (C6) segment of the internal carotid artery (ICA) constitute 5% to 11% of all intracranial aneurysms; 25% of these aneurysms are giant, and 50% are multiple. Critical to the successful treatment of these aneurysms is an understanding of the embryologic development, regional anatomy, and radiographic techniques. In part 1 of this review, we discuss theories of Dorcas Hager Padget (neuroembryologist and neurosurgical illustrator) and Pierre Lasjaunias to clarify the complex embryology of this cerebral vasculature and to identify the vascular anomalies of the C6 segment. Next, we provide comprehensive detail of the bone, connective tissue, and vascular structures that are intimately related in the confining space surrounding the distal dural ring (DDR) and anterior clinoid process. The anatomic complexity of the region surrounding the C6 segment of the ICA partly explains the surgical challenge in treating aneurysms of this segment and the relatively high incidence of postoperative complications. We review the radiologic techniques to assess these aneurysms when planning treatment, such as the role of cerebral angiography in providing details about the hemodynamic function of the vessels (eg, collateral circulation pattern, potential recipient vessels for bypass) and the role of the DDR in distinguishing aneurysms of the extradural or intradural segment of the ICA. Although these aneurysms remain challenging, the information reviewed in part 1 helps to understand these aneurysms more clearly in terms of embryology, anatomy, and radiology for successful treatment strategies. Applications of this information are discussed in part 2, in which we review clinical experience and treatment strategies.A neurysms arising from the intradural ophthalmic (C6) segment 1 of the internal carotid artery (ICA) constitute approximately 5% to 11% of all intracranial aneurysms. A significant 25% of these aneurysms are giant, and approximately 50% are multiple. 2-4 These aneurysms are traditionally regarded as challenging lesions because of the anatomical complexity of the region. Aneurysms of the C6 segment arise from the ICA between the distal dural ring (DDR) and the origin of the posterior communicating artery. The term ophthalmic refers to the main branch, the ophthalmic artery, which arises from this segment. Understanding the complex embryology of cerebral vasculature is critical to explain the anatomical variations commonly associated with these vessels. After early embryologic studies, the seminal treatise of Dorcas Hager Padget on ''The development of the cranial arteries in the human embryo'' contributed significantly to the understanding of this embryology 5 but did not address vascular anomalies. Subsequently, Pierre Lasjaunias and his colleagues explained a number of the vascular anomalies in this region (eg, theories of extradural origin of the ophthalmic artery). 6-10 We draw from the theories of Padget and Lasjaunias to clarify the most frequently occurring vascular anoma...

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Section: Dural Relationsmentioning

confidence: 99%

Aneurysms of the Ophthalmic (C6) Segment of the Internal Carotid Artery

Beretta¹,

Andaluz²,

Zuccarello³

et al. 2005

Neurosurgery Quarterly

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“…11,21 This small pouch, termed the carotid cave by Kobayashi et al, 11 is present in 68% to 90% of cadaveric specimens 6,9,19 and is where the paraclinoid aneurysms of the medial type (or posterior type with a medial component), carotid cave, and superior hypophyseal artery aneurysms arise. Aneurysms of these types can be intradural and are at risk for subarachnoid hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the effectiveness of using the optic strut and tuberculum sellae as radiological landmarks in diagnosing paraclinoid aneurysms with CT angiography

Liao

Lin²,

Lin

et al. 2016

JNS

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T he treatment of paraclinoid aneurysms remains challenging. 7,8,10,17,18,25 It is important to differentiate the exact location of the paraclinoid aneurysm, whether intradural or not, when considering treatment options. The distal dural ring (DDR) is the anatomical boundary between the intra-and extradural segments of the internal carotid artery (ICA) in the paraclinoid region. 2,9,19,24 Some studies tried to delineate the DDR with imaging methods and differentiate the aneurysm in the vicinity of the anterior clinoid process (ACP). 5,16,23 However, these studies either lacked direct surgical confirmation or comprised a small case number.aBBreViatiONS ACP = anterior clinoid process; C 4 = cavernous segment; C 5 = clinoid segment; C 6 = ophthalmic segment; CTA = CT angiography; DDR = distal dural ring; DSA = digital subtraction angiography; ICA = internal carotid artery; OphA = ophthalmic artery; OS = optic strut; PDR = proximal dural ring; ROC = receiver operating characteristic; TS = tuberculum sellae. OBJectiVe The treatment of paraclinoid aneurysms remains challenging. It is important to determine the exact location of the paraclinoid aneurysm when considering treatment options. The authors herein evaluated the effectiveness of using the optic strut (OS) and tuberculum sellae (TS) as radiographic landmarks for distinguishing between intradural and extradural paraclinoid aneurysms on source images from CT angiography (CTA). methOdS Between January 2010 and September 2013, a total of 49 surgical patients with the preoperative diagnoses of paraclinoid aneurysm and 1 symptomatic cavernous-clinoid aneurysm were retrospectively identified. With the source images from CTA, the OS and the TS were used as landmarks to predict the location of the paraclinoid aneurysm and its relation to the distal dural ring (DDR). The operative findings were examined to confirm the definitive location of the paraclinoid aneurysm. Statistical analysis was performed to determine the diagnostic effectiveness of the landmarks. reSultS Nineteen patients without preoperative CTA were excluded. The remaining 30 patients comprised the current study. The intraoperative findings confirmed 12 intradural, 12 transitional, and 6 extradural paraclinoid aneurysms, the diagnoses of which were significantly related to the type of aneurysm (p < 0.05) but not factors like sex, age, laterality of aneurysm, or relation of the aneurysm to the ophthalmic artery on digital subtraction angiography. To measure agreement with the correct diagnosis, the OS as a reference point was far superior to the TS (Cohen's kappa coefficients 0.462 and 0.138 for the OS and the TS, respectively). For paraclinoid aneurysms of the medial or posterior type, using the base of the OS as a reference point tended to overestimate intradural paraclinoid aneurysms. The receiver operating characteristic curve indicated that if the aneurysmal neck traverses the axial plane 2 mm above the base of the OS, the aneurysm is most likely to grow across the DDR and present as a transitional ane...

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“…5 Intradural paraclinoid aneurysms carry a risk of subarachnoid hemorrhage (SAH) and can be treated, but extradural cavernous sinus aneurysms present little or no risk of SAH and usually require only follow-up observation in asymptomatic patients. Because the carotid cave, observed in two-thirds of cadavers in 2 studies, 5,6 is a small intradural recess at the posteriormedial aspect of the DDR, it is di‹cult to distinguish intra-from extradural aneurysms at the medial side of the C2 portion. 7 Therefore, identiˆcation of the DDR is important, especially in cases of medial ICA aneurysms.…”

Section: Discussionmentioning

confidence: 99%

3D MR Cisternography to Identify Distal Dural Rings: Comparison of 3D-CISS and 3D-SPACE Sequences

et al. 2011

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Purpose: The distal dural ring (DDR) is an anatomical landmark used to distinguish intra-and extradural aneurysms. We investigated identiˆcation of the DDR using 2 threedimensional (3D) magnetic resonance (MR) cisternography sequences-3D constructive interference in steady state (CISS) and 3D sampling perfection with application optimized contrasts using diŠerent ‰ip angle evolutions (SPACE)-at 3.0 tesla.Methods: Ten healthy adult volunteers underwent imaging with 3D-CISS, 3D-SPACE, and time-of-‰ight (TOF) MR angiography (TOF-MRA) sequences at 3.0T. We analyzed DDR identiˆcation and internal carotid artery (ICA) signal intensity and classiˆed the shape of the carotid cave.Results: We identiˆed the DDR using both 3D-SPACE and 3D-CISS, with no signiˆcant diŠerence between the sequences. Visualization of the outline of the ICA in the cavernous sinus (CS) was signiˆcantly clearer with 3D-SPACE than 3D-CISS. In the CS and petrous portions, signal intensity was lower with 3D-SPACE, and the ‰ow void was poor with 3D-CISS in some subjects.Conclusion: We identiˆed the DDR with both 3D-SPACE and 3D-CISS, but the superior contrast of the ICA in the CS using 3D-SPACE suggests the superiority of this sequence for evaluating the DDR.

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Micro-anatomical study of the carotid cave

Cited by 34 publications

References 15 publications

Aneurysms of the Ophthalmic (C6) Segment of the Internal Carotid Artery

Aneurysms of the Ophthalmic (C6) Segment of the Internal Carotid Artery

Comparison of the effectiveness of using the optic strut and tuberculum sellae as radiological landmarks in diagnosing paraclinoid aneurysms with CT angiography

3D MR Cisternography to Identify Distal Dural Rings: Comparison of 3D-CISS and 3D-SPACE Sequences

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