Review of the main surgical and angiographic-oriented classifications of the course of the internal carotid artery through a novel interactive 3D model

  • Marc Valera Melé
  • Anna Puigdellívol-SánchezEmail author
  • Marija Mavar-Haramija
  • Juan A. Juanes-Méndez
  • Luis San Román
  • Matteo De Notaris
  • Giuseppe Catapano
  • Alberto Prats-Galino


The course of the internal carotid artery (ICA) and its segment classifications were reviewed by means of a new and freely available 3D interactive model of the artery and the skull base, based on human neuroimages, that can be freely downloaded at the Public Repository of the University of Barcelona ( and runs under Acrobat Reader in Mac and Windows computers and Windows 10 tablets. The 3D-PDF allows zoom, rotation, selective visualization of structures, and a predefined sequence view. Illustrative images of the different classifications were obtained. Fischer (Zentralbl Neurochir 3:300–313, 1938) described five segments in the opposite direction to the blood flow. Gibo-Rothon (J Neurosurg 55:560–574, 1981) follow the blood flow, incorporated the cervical and petrous portions, and divided the subarachnoid course—supraclinoid—in ophthalmic, communicating, and choroidal segments, enhancing transcranial microscopic approaches. Bouthillier (Neurosurgery 38:425–433, 1996) divided the petrous portion describing the lacerum segment (exposed in transfacial procedures and exploration of Meckel’s cave) and added the clinoid segment between the proximal and distal dural rings, of interest in cavernous sinus surgery. The Kassam’s group (2014), with an endoscopic endonasal perspective, introduces the “paraclival segment,” including the “lacerum segment” and part of the intracavernous ICA, and details surgical landmarks to minimize the risk of injury. Other classifications are also analyzed. This review through an interactive 3D tool provides virtual views of the ICA and becomes an innovative perspective to the segment classifications and neuroanatomy of the ICA and surrounding structures.


Internal carotid artery segments Anatomic models Skull base anatomy CT angiography 3D angiography 3D-PDF document 



The authors are grateful to Olga Fuentes for her contribution to image processing.


This study was funded by the Fundació Marató TV3 Project [411/U/2011—TITLE: Quantitative analysis and computer aided simulation of minimally invasive approaches for intracranial vascular lesions].

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical statement

All procedures were in accordance with the ethical standards of the institution and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Supplementary material

10143_2018_1012_MOESM1_ESM.pdf (11.7 mb)
ESM 1 (PDF 12006 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Marc Valera Melé
    • 1
    • 2
  • Anna Puigdellívol-Sánchez
    • 1
    • 3
    Email author
  • Marija Mavar-Haramija
    • 1
  • Juan A. Juanes-Méndez
    • 4
  • Luis San Román
    • 5
  • Matteo De Notaris
    • 6
  • Giuseppe Catapano
    • 6
  • Alberto Prats-Galino
    • 1
  1. 1.Laboratory of Surgical Neuroanatomy, Human Anatomy and Embryology Unit, Faculty of Medicine and Health SciencesUniversity of BarcelonaBarcelonaSpain
  2. 2.Hospital General Universitario Gregorio Marañón, Servicio de NeurocirugíaMadridSpain
  3. 3.CAP Antón BorjaConsorci Sanitari de TerrassaRubíSpain
  4. 4.VisualMed System Group, Human Anatomy and Histology DepartmentUniversity of SalamancaSalamancaSpain
  5. 5.Clinic Center of Diagnostic by Imaging–Angioradiology, Hospital ClinicBarcelonaSpain
  6. 6.Neurosurgery Operative Unit, Department of NeuroscienceG Rummo HospitalBeneventoItaly

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