Ismail Mostafa, Darwish Mohab, Tahan Abd El Rahman El, Herzallah Islam R
Department of Otorhinolaryngology, Minia University Hospital, Minia University, Minia, Egypt.
Department of Neurosurgery, Minia University Hospital, Minia University, Minia, Egypt.
Int Arch Otorhinolaryngol. 2023 Aug 4;27(3):e455-e460. doi: 10.1055/s-0042-1749391. eCollection 2023 Jul.
In sphenoid sinuses with ill-defined carotid bony landmarks, accidental injury of the internal carotid artery (ICA) remains one of the most challenging complications, which is particularly reported in the endoscopic endonasal transsphenoidal approaches (EETAs). To describe an anatomical model for the endoscopic orientation of the juxta-pituitary segment of the ICA in relation to the lateral opticocarotid recess (OCR) as a nearby bony landmark. Dissection was performed progressively, simulating the EETA, in twenty fresh adult cadavers. After reducing the posterior and lateral walls of the sphenoid sinuses, various measurements were taken from both lateral OCRs to "contact points" on the juxta-pituitary segment of the ICA and lateral margins of the pituitary gland. The current results have enabled us to divide the region between the lateral OCRs into 3 compartments: 2 lateral parasellar compartments contain juxta-pituitary segments of the ICA with a mean width of 8 mm and a narrow range from 7 mm to 10 mm; and a central intercarotid sellar compartment represents the safe region for bone drilling, showing widely variable widths ranging from 9 mm to 20mm. In all specimens, the variation in the width of the intercarotid compartment correlated with the distance between both lateral OCRs. The present study improves surgeon awareness of the variations in the course of the ICA through the EETA along sphenoid sinuses with ill-defined bony landmarks. An appreciation of the measurements taken in the present study can help in operative training, and can also provide a base for future studies to confirm ICA courses associated with a higher risk of injury.
在蝶窦中，若颈动脉骨性标志不明确，颈内动脉（ICA）意外损伤仍是最具挑战性的并发症之一，在内镜鼻内经蝶窦入路（EETAs）中尤其如此。描述一种解剖模型，用于确定ICA垂体旁段相对于作为附近骨性标志的外侧视交叉颈动脉隐窝（OCR）的内镜定位。在20具新鲜成人尸体上逐步进行解剖，模拟EETA。在去除蝶窦后壁和侧壁后，从两侧的外侧OCR到ICA垂体旁段及垂体外侧缘的“接触点”进行了各种测量。目前的结果使我们能够将外侧OCR之间的区域分为3个腔室：2个外侧鞍旁腔室包含ICA垂体旁段，平均宽度为8mm，范围狭窄，从7mm到10mm；中央颈动脉间鞍隔腔室是安全的骨钻孔区域，宽度变化很大，从9mm到20mm。在所有标本中，颈动脉间腔室宽度的变化与两侧外侧OCR之间的距离相关。本研究提高了外科医生对通过EETA在骨性标志不明确的蝶窦中ICA走行变异的认识。了解本研究中的测量值有助于手术训练，也可为未来确认与更高损伤风险相关的ICA走行的研究提供基础。
