Felix Vinod, Suresh Anupama, K P Gopakumar, A Lakshmi
Department of ENT, KIMSHEALTH, PB N0:1, Anayara P.O, Thiruvananthapuram, Kerala 695029 India.
Department of Radiology, KIMSHEALTH, PB N0:1, Anayara P.O, Thiruvananthapuram, Kerala 695029 India.
Indian J Otolaryngol Head Neck Surg. 2024 Oct;76(5):4179-4183. doi: 10.1007/s12070-024-04810-9. Epub 2024 Jun 21.
Internal carotid artery injury is one of the most feared intraoperative complications of endoscopic sinus surgery and endoscopic skull base surgery. Vidian canal is used as a landmark to identify laceral genu of ICA. But, this structure leads to the lateral aspect of the genu and so, there is still a possibility of injuring the genu, if we blindly follow this landmark. So, to find out a more reliable landmark to locate ICA, we conducted a computed tomography-based study in our institution. The aim was to evaluate the anatomical variations in position of palatovaginal canal in relation to laceral genu of ICA. The primary objective was to know the anatomical relation of medial opening of PVC to laceral genu of ICA, and the secondary objective was to measure the distance between these two structures. CT paranasal sinus images of 105 patients were collected and axial cuts evaluated to find out the anatomical relation between PVC and ICA. In 97.1% of the scans, laceral genu of ICA was found lateral to medial opening of PVC, and in the rest 2.9%, both structures were found to lie in the same line. In 62.9% of the patients, the distance between the two structures was found to be between 3.1 and 6 mm. The inter-palatovaginal canal corridor can possibly be considered as a safe corridor to clival region of sphenoid sinus. This corridor can be easily identified intraoperatively during endoscopic skull base surgeries So, if the surgeon limits the instrumentation to the inter-palatovaginal canal corridor, iatrogenic injury to ICA, one of the most dreaded complications, can be avoided, while working in the clival region of sphenoid sinus.
颈内动脉损伤是鼻内镜鼻窦手术和鼻内镜颅底手术中最可怕的术中并发症之一。翼管被用作识别颈内动脉膝部的标志。但是，这个结构通向膝部的外侧，因此，如果我们盲目遵循这个标志，仍然有可能损伤膝部。所以，为了找到一个更可靠的标志来定位颈内动脉，我们在我们的机构进行了一项基于计算机断层扫描的研究。目的是评估翼腭管位置相对于颈内动脉膝部的解剖变异。主要目的是了解翼腭管内侧开口与颈内动脉膝部的解剖关系，次要目的是测量这两个结构之间的距离。收集了105例患者的鼻窦CT图像，并对轴位切片进行评估，以找出翼腭管与颈内动脉之间的解剖关系。在97.1%的扫描中，颈内动脉膝部位于翼腭管内侧开口的外侧，其余2.9%的扫描中，发现这两个结构位于同一条线上。在62.9%的患者中，发现这两个结构之间的距离在3.1至6毫米之间。翼腭管间通道可能被认为是蝶窦斜坡区域的一条安全通道。在内镜颅底手术中，这条通道在术中很容易识别。所以，如果外科医生将器械操作限制在翼腭管间通道内，在蝶窦斜坡区域操作时，就可以避免颈内动脉这一最可怕的并发症之一的医源性损伤。
