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Identification of the internal carotid artery at the superior part of the cavernous sinus during endoscopic endonasal cavernous sinus tumor surgery

  • Technical Note - Neurosurgical Anatomy
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Abstract

Background

Identification of the internal carotid artery (ICA) is essential for successful endoscopic endonasal cavernous sinus tumor surgery. This study aimed to develop a method for identifying the ICA in cavernous sinus tumors at the superior part of the cavernous sinus.

Methods

Ten fresh cadavers were studied with a 4-mm 0° and 30° endoscope to identify surgical landmarks of the ICA in the cavernous sinus. Clinical cases of cavernous sinus tumors were surgically treated using an endoscopic transpterygoid approach.

Results

Anatomical study indicated the ICA at the superior part of the cavernous sinus can be identified using three steps: 1) exposure of the optic nerve sheath by drilling the optic canal; 2) identification of the proximal orifice of the optic nerve sheath at the transition of the optic nerve sheath and dura mater of the tuberculum sellae; and 3) identification of the clinoid segment of the ICA at the distal dural ring just below the proximal orifice of the optic nerve sheath. Although the ICA was encased and transposed by tumors in preliminary surgical cases, the clinoid segment of the ICA was safely exposed at the superior part of the cavernous sinus using this method.

Conclusions

Dural structures around the cavernous sinus are key to identifying the ICA at the superior part of the cavernous sinus. This method is expected to reduce the risk of ICA injury during endoscopic endonasal surgery for cavernous sinus tumors.

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Conflicts of interest

The authors report no conflicts of interest concerning the materials and methods used in this study and the findings specified in this paper.

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Authors and Affiliations

  1. Department of Neurosurgery, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan

    Fuminari Komatsu, Masami Shimoda, Shinri Oda, Masaaki Imai & Hideaki Shigematsu

  2. Center of Anatomy & Cell Biology, Medical University of Vienna, Vienna, Austria

    Fuminari Komatsu, Mika Komatsu & Manfred Tschabitscher

  3. Department of Neurosurgery, Tokai University School of Medicine, Kanagawa, Japan

    Mitsunori Matsumae

Authors
  1. Fuminari Komatsu
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  2. Masami Shimoda
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  3. Shinri Oda
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  4. Masaaki Imai
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  5. Hideaki Shigematsu
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  6. Mika Komatsu
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  7. Manfred Tschabitscher
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  8. Mitsunori Matsumae
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Correspondence to Fuminari Komatsu.

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Komatsu, F., Shimoda, M., Oda, S. et al. Identification of the internal carotid artery at the superior part of the cavernous sinus during endoscopic endonasal cavernous sinus tumor surgery. Acta Neurochir 156, 475–479 (2014). https://doi.org/10.1007/s00701-013-1986-4

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  • DOI: https://doi.org/10.1007/s00701-013-1986-4

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