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Endoscopic Orientation of Juxta-Pituitary Carotid in Transsphenoidal Approaches: Critical Considerations for Clinical Applications

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Indian Journal of Otolaryngology and Head & Neck Surgery Aims and scope Submit manuscript

Abstract

Accidental injury of the internal carotid artery (ICA) remains one of the most challenging complications reported in the endoscopic endonasal transsphenoidal approaches (EETA) particularly, in sphenoid sinuses with ill-defined carotid bony landmarks. The purpose of this study was to describe an anatomical model for the endoscopic orientation of juxta-pituitary segment of ICA in relation to the lateral optico-carotid recess (OCR) as a nearby bony landmark. Cadaveric dissection was conducted progressively in twenty fresh adult cadavers simulating the EETA. After reducing posterior and lateral walls of sphenoid sinuses, various measurements were taken from both lateral OCRs to "contact points" of the juxta-pituitary segment of ICA and lateral margins of the pituitary gland. Current results have enabled us to divide the region between lateral OCRs into three compartments. Two lateral parasellar compartments contain juxta-pituitary segments of ICA showing a mean width of 8 mm; with a narrow range of 7–10 mm; and a central inter-carotid sellar compartment represents the safe region for bone drilling showing widely variable widths ranging between 9 to 20 mm. In all specimens; variation in the width of the inter-carotid compartment correlated with the distance between both lateral OCRs. This study improves surgeons’ awareness of the ICA course variations in the EETA through sphenoid sinuses with ill-defined bony landmarks. An appreciation of the measurements gathered from this study can help in operative training, and can also provide a base for future studies to confirm ICA courses associated with higher risk of injury.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Minia University Hospital, Minia University, Kornish El Nile St., El Minia, Minya, Egypt

    Mostafa Ismail & Mohamed Gomma

  2. Department of Neurosurgery, Minia University Hospital, Minia University, Minya, Egypt

    Mohab Darwish

  3. Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt

    Islam R. Herzallah

  4. Department of Otorhinolaryngology, Suez University Hospital, Suez University, Suez, Egypt

    Abd El Rahman El Tahan

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  1. Mostafa Ismail
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  2. Mohab Darwish
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  3. Mohamed Gomma
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  4. Islam R. Herzallah
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  5. Abd El Rahman El Tahan
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Correspondence to Mostafa Ismail.

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Ismail, M., Darwish, M., Gomma, M. et al. Endoscopic Orientation of Juxta-Pituitary Carotid in Transsphenoidal Approaches: Critical Considerations for Clinical Applications. Indian J Otolaryngol Head Neck Surg 73, 461–466 (2021). https://doi.org/10.1007/s12070-021-02454-7

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  • DOI: https://doi.org/10.1007/s12070-021-02454-7

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