This work was supported by FAPESP (Fundação de Amparo a Pesquisa do Estado de São Paulo). The authors have no other funding, financial relationships, or conflicts of interest to disclose.
Endonasal endoscopic exposure of the internal carotid artery: An anatomical study†
Version of Record online: 17 JAN 2012
Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.
Volume 122, Issue 2, pages 445–451, February 2012
How to Cite
Fortes, F. S. G., Pinheiro-Neto, C. D., Carrau, R. L., Brito, R. V., Prevedello, D. M. and Sennes, L. U. (2012), Endonasal endoscopic exposure of the internal carotid artery: An anatomical study. The Laryngoscope, 122: 445–451. doi: 10.1002/lary.22395
- Issue online: 23 JAN 2012
- Version of Record online: 17 JAN 2012
- Manuscript Accepted: 2 AUG 2011
- Manuscript Revised: 31 JUL 2011
- Manuscript Received: 23 MAY 2011
- skull base surgery;
- internal carotid artery;
- infratemporal fossa;
- eustachian tube;
- transpterygoid approach;
- Level of Evidence: 2b
The aim of this work was to define the anatomical landmarks, limitations, and difficulties of obtaining internal carotid artery (ICA) exposure via endonasal endoscopic approaches (EEA).
Cadaveric descriptive study.
The ICA was dissected via EEA in 10 cadaveric specimens (20 sides) prepared with intravascular injections of colored silicone. We carried the ICA dissection from the cavernous to the distal parapharyngeal segments through a transpterygoid corridor.
The transpterygoid approach provided adequate exposure of the lacerum and horizontal petrous ICA. Additional exposure of the ICA and the infrapetrous area required resection of the eustachian tube (ET) and the fibrocartilaginous tissue of the foramen lacerum after a medial maxillectomy and resection of the pterygoid plates. The main anatomical landmarks to the corresponding ICA segment include: the vidian nerve that points to the lacerum and horizontal segments, the mandibular nerve (V3) that heralds the petrous segment, the foramen ovale and the ET that signal toward the carotid canal, and the posterior trunk of the mandibular nerve (V3) and the ET that mark the parapharyngeal segment.
EEAs provide access to the ICA from its cavernous to the distal parapharyngeal segments. A stepwise approach is critical to its exposure and control. Surgeons must be aware of its frequently tortuous three-dimensional course and the intimate relation of the vessel to the carotid canal and the cartilage of the foramen lacerum.