Surgery of Internal Carotid Artery within the Parasellar Space (CS)

Abstract

Despite incredible success in endovascular treatment of intracranial vascular lesions (parasellar large and giant aneurysms), those likely to present with periorbital pain and neurological symptoms—as well as the associated risk of creating spontaneous high-flow fistulae, even devastating SAH—cannot be effectively and completely eliminated from the cerebral circulation by endovascular techniques without sacrificing the ICA. For such lesions, the extradural approach provides a safe, efficient, practical surgical method in which the lesion might be successfully excluded, and the patency of the ICA preserved. The second category of the ICA lesions necessitates that the surgeon deal with high-flow CC fistulae, completely trans-sected ICA, and/or transpierced ICA in the region. Among these absolute indications for surgical treatment, other vascular lesions in the parasellar space will be discussed on the basis of the author's experience with more than 250 personally executed procedures for vascular lesions in the parasellar space.