Length Of Internal Carotid Artery Research Articles

Morphometric Comparison of the Pterional Trans-Sylvian and the Pretemporal Trans-Clinoidal Approaches to the Posterior Communicating Artery.

Posterior communicating (Pcom) aneurysms in the modern era have tended toward increased complexity and technical difficulties. The pretemporal approach is a valuable extension to the pterional approach for basilar apex aneurysms, but its advantages for Pcom aneurysms have not been previously elucidated. To quantify characteristics of the pretemporal approach to the Pcom. We dissected 6 cadaveric heads (12 sides) with a pretemporal transclinoidal approach and measured the following variables: (1) exposed length of internal carotid artery (ICA) proximal to the Pcom artery; (2) exposed circumference of ICA at the origin of Pcom; (3) deep working area between the optic nerve and tentorium/oculomotor nerve; (4) superficial working area; (5) exposure depth; and (6) the frontotemporal (superior posterolateral) and (7) orbito-sphenoidal (inferior anterolateral) angles of exposure. Compared with pterional craniotomy, the pretemporal transclinoidal approach increased the exposed length of the proximal ICA from 3.3 to 11.7 mm (P=.0001) and its circumference from 5.1 to 7.8 mm (P=.0003), allowing a 210° view of the ICA (vs 137.9°). The deep and superficial working areas also significantly widened from 53.7 to 92.4 mm2 (P=.0048) and 252.8 to 418.2 mm2 (P=.0001), respectively; the depth of the exposure was equivalent. The frontotemporal and spheno-Sylvian angles increased by 17° (P=.0006) and 10° (P=.0037), respectively. The pretemporal approach can be useful for complex Pcom aneurysms by providing easier proximal control, wider working space, improved aneurysm visualization, and more versatile clipping angles. Enhanced exposure results in a potentially higher rate of complete aneurysm obliteration and complication avoidance.

Extending the boundaries of carotid body tumor excision with a maxillofacial surgeon

Introduction: Carotid body tumor (CBT) excision at times requires a multidisciplinary approach. Requests for mandibular swing or mandibular subluxation were received by the department of dental and oral surgery to aid in CBT excision. Methods: Patients who were referred between March 2013 and April 2018 were retrospectively reviewed. Criteria for deciding between mandibular swing and mandibular subluxation for each patient were identified and outcome of the decision was analyzed. Follow-up period was 6 months to 5 years. Results: Of 53 patients operated during the study, 16 patients were referred for intraoperative assistance. Of the 16 patients, 10 were Shamblin 3 with 2 of these being redo cases and others were Shamblin 2. In all cases, the length of internal carotid artery (ICA) from the base of the skull was 1.5 cm or less. Mandibular swing was performed in three patients, all for Shamblin 3 with two of them being the redo cases, and mandibular subluxation was done for 13 patients. One patient who underwent mandibular swing and two patients who had mandibular subluxation had transient hypoglossal nerve palsy and all of them recovered. None of the patients for whom a mandibular swing was done had marginal mandibular nerve weakness. One patient lost a tooth at the mandibular osteotomy site. All patients had an acceptable scar. Among the patients who underwent mandibular subluxation, one patient had postoperative temporomandibular joint pain, which gradually subsided over 3 weeks. Conclusions: Mandibular swing and mandibular subluxation help provide the vascular surgeon with the additional space needed when excising CBTs, which extend close to the base of the skull with 1.5 cm or less of ICA from the base of the skull. The maneuvers help easier dissection and reconstruction of the ICA, reduce nerve injury and operating time, and reduce hospital stay and therefore cost to the patient.