TY - JOUR
T1 - Finding the Petroclival Carotid Artery
T2 - The Vidian-Eustachian Junction as a Reliable Landmark
AU - Oakley, Gretchen M.
AU - Ebenezer, Jareen
AU - Hamizan, Aneeza
AU - Sacks, Peta Lee
AU - Rom, Darren
AU - Sacks, Raymond
AU - Winder, Mark
AU - Davidson, Andrew
AU - Teo, Charles
AU - Solares, C. Arturo
AU - Harvey, Richard J.
N1 - Funding Information:
Gretchen M. Oakley is a consultant with Stryker. Richard J. Harvey is a consultant with Medtronic, Olympus, and NeilMed, Advisory Board for Seqiris and has received grant support from ENTTec, Stallergenes, and NeilMed. Raymond Sacks is a previous and Arturo Solares a current consultant with Medtronic. Charles Teo is a consultant for Aesculap.
Publisher Copyright:
© 2018 Georg Thieme Verlag KG Stuttgart New York.
PY - 2018/8/1
Y1 - 2018/8/1
N2 - Introduction Identifying the internal carotid artery (ICA) when managing petroclival and infratemporal fossa pathology is essential for the skull base surgeon. The vidian nerve and eustachian tube (ET) cartilage come together at the foramen lacerum, the vidian-eustachian junction (VEJ). The ICA position, relative to the VEJ is described. Methods Endoscopic dissection of adult fresh-frozen cadaver ICAs and a case series of patients with petroclival pathology were performed. The relationship of the VEJ to the ICA horizontal segment, vertical segment, and second genu was assessed. The distance of the ICA second genu to VEJ was determined in coronal, axial, and sagittal planes. The length of the vidian nerve and ET was measured from the pterygopalatine fossa (PPF) and nasopharyngeal orifice to the VEJ. Results In this study, 10 cadaver dissections (82.3 ± 6.7 years, 40% female) were performed. The horizontal petrous ICA was at or behind VEJ in 100%, above VEJ in 100%, and lateral to VEJ in 80%. The vertical paraclival segment was at or behind VEJ in 100%, above in 100%, and medial in 100%. The second genu was at or behind VEJ in 100% (3.3 ± 2.4 mm), at or above in 100% (2.5 ± 1.6 mm), and medial in 100% (3.4 ± 2.0 mm). The VEJ was successfully used to locate the ICA in nine consecutive patients (53.3 ± 13.6 years, 55.6% female) where pathology was also present. The VEJ was 15.0 ± 6.0 mm from the ET and 17.4 ± 4.1 mm from the PPF. Conclusion The VEJ is an excellent landmark as it defines both superior and posterior limits when isolating the ICA in skull base surgery.
AB - Introduction Identifying the internal carotid artery (ICA) when managing petroclival and infratemporal fossa pathology is essential for the skull base surgeon. The vidian nerve and eustachian tube (ET) cartilage come together at the foramen lacerum, the vidian-eustachian junction (VEJ). The ICA position, relative to the VEJ is described. Methods Endoscopic dissection of adult fresh-frozen cadaver ICAs and a case series of patients with petroclival pathology were performed. The relationship of the VEJ to the ICA horizontal segment, vertical segment, and second genu was assessed. The distance of the ICA second genu to VEJ was determined in coronal, axial, and sagittal planes. The length of the vidian nerve and ET was measured from the pterygopalatine fossa (PPF) and nasopharyngeal orifice to the VEJ. Results In this study, 10 cadaver dissections (82.3 ± 6.7 years, 40% female) were performed. The horizontal petrous ICA was at or behind VEJ in 100%, above VEJ in 100%, and lateral to VEJ in 80%. The vertical paraclival segment was at or behind VEJ in 100%, above in 100%, and medial in 100%. The second genu was at or behind VEJ in 100% (3.3 ± 2.4 mm), at or above in 100% (2.5 ± 1.6 mm), and medial in 100% (3.4 ± 2.0 mm). The VEJ was successfully used to locate the ICA in nine consecutive patients (53.3 ± 13.6 years, 55.6% female) where pathology was also present. The VEJ was 15.0 ± 6.0 mm from the ET and 17.4 ± 4.1 mm from the PPF. Conclusion The VEJ is an excellent landmark as it defines both superior and posterior limits when isolating the ICA in skull base surgery.
KW - anatomy
KW - endoscopic surgery
KW - eustachian tube
KW - internal carotid artery
KW - skull base
KW - vidian nerve
UR - http://www.scopus.com/inward/record.url?scp=85035346249&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85035346249&partnerID=8YFLogxK
U2 - 10.1055/s-0037-1608650
DO - 10.1055/s-0037-1608650
M3 - Article
AN - SCOPUS:85035346249
SN - 2193-634X
VL - 79
SP - 361
EP - 366
JO - Journal of Neurological Surgery, Part B: Skull Base
JF - Journal of Neurological Surgery, Part B: Skull Base
IS - 4
ER -