Preoperative localization of the carotid bifurcation for cervical carotid exposure using the mastoid-hyoid line

 

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Background and Importance: The location of the carotid bifurcation (CB) is highly variable, which makes precise exposure of the cervical carotid artery difficult, especially in transverse incisions. The method for preoperative localization of the CB is not well established. We used the distance from the mastoid-hyoid (M-H) line to the CB, measured preoperatively with computed tomography angiography, to localize the location of the transverse skin incision. We describe and evaluate the accuracy of a method for preoperative localization of the CB for cervical carotid exposure. Methods: The researchers retrospectively evaluated 16 patients with aneurysms arising from the internal carotid artery (ICA) who had received cervical carotid exposure using the localization method of incision and were retrospectively evaluated from February 2018 to November 2019. The method of measurement and localization of the skin incision are described, and two illustrative cases are demonstrated. Results: Saccular aneurysms of the ophthalmic (C2) segment and communicating (C1) segment of the ICA were found in 8 and 8 patients, respectively. Nine patients had left-sided exposure, and 7 patients had right-sided exposure. The mean distance from the M-H line to the CB was 2.1 cm (range 0.5–3.5 cm). The accuracy of this method was 93.8%. No paralysis of the depressor anguli oris or the depressor labii inferioris was found postoperatively. Conclusion: The distance from the M-H line to the CB can be used to estimate transverse skin incisions for cervical carotid exposure.

Financial support and sponsorship

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Publication History

Received: 09 June 2020

Accepted: 25 July 2020

Article published online:
16 August 2022

© 2020. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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• References

• 1 Weaver K, Huang J, Tamargo RJ, Bernard EJ Jr. Preoperative localization of the carotid bifurcation for carotid endarterectomy using magnetic resonance angiography without tomography: Technical note. Neurosurgery 2004;55:1227.
• 2 Barami K, Hernandez VS, Diaz FG, Guthikonda M. Paraclinoid carotid aneurysms: Surgical management, complications, and outcome based on a new classification scheme. Skull Base 2003;13:31-41.
• 3 Flores BC, White JA, Batjer HH, Samson DS. The 25th anniversary of the retrograde suction decompression technique (Dallas technique) for the surgical management of paraclinoid aneurysms: Historical background, systematic review, and pooled analysis of the literature. J Neurosurg 2018;130:902-16.
• 4 Kamide T, Burkhardt JK, Tabani H, Safaee M, Lawton MT. Microsurgical clipping techniques and outcomes for paraclinoid internal carotid artery aneurysms. Oper Neurosurg (Hagerstown) 2020;18:183-92.
• 5 Ishishita Y, Tanikawa R, Noda K, Kubota H, Izumi N, Katsuno M, et al. Universal extracranial-intracranial graft bypass for large or giant internal carotid aneurysms: Techniques and results in 38 consecutive patients. World Neurosurg 2014;82:130-9.
• 6 Denli Yalvac ES, Baran O, Aydin AE, Balak N, Tanriover N. Surgical Pitfalls in Carotid Endarterectomy: A New Step-By-Step Approach. J Craniofac Surg 2018;29:2337-43.
• 7 Klosek SK, Rungruang T. Topography of carotid bifurcation: Considerations for neck examination. Surg Radiol Anat 2008;30:383-7.
• 8 Shen XH, Xue HD, Chen Y, Wang M, Mirjalili SA, Zhang ZH, et al. A reassessment of cervical surface anatomy via CT scan in an adult population. Clin Anat 2017;30:330-5.
• 9 Mirjalili SA, McFadden SL, Buckenham T, Stringer MD. Vertebral levels of key landmarks in the neck. Clin Anat 2012;25:851-7.
• 10 Mc AD, Anson BJ, Mc DJ. Variation in the point of bifurcation of the common carotid artery. Q Bull Northwest Univ Med Sch 1953;27:226-9.
• 11 Michalinos A, Chatzimarkos M, Arkadopoulos N, Safioleas M, Troupis T. Anatomical considerations on surgical anatomy of the carotid bifurcation. Anat Res Int 2016;2016:6907472.
• 12 Denli Yalvac ES, Balak N, Atalay B, Bademci MS, Kocaaslan C, Oztekin A, et al. A new method for determining the level of the carotid artery bifurcation. J Craniofac Surg 2019;30:e523-e527.
• 13 Ozgur Z, Govsa F, Ozgur T. Anatomic evaluation of the carotid artery bifurcation in cadavers: Implications for open and endovascular therapy. Surg Radiol Anat 2008;30:475-80.
• 14 Kurkcuoglu A, Aytekin C, Oktem H, Pelin C. Morphological variation of carotid artery bifurcation level in digital angiography. Folia Morphol (Warsz) 2015;74:206-11.
• 15 Harwood AE, Leung CC, Smith GE, Chetter IC. Extreme low-lying carotid bifurcations. Vasc Med 2016;21:394-5.
• 16 Kato Y, Sano H, Katada K, Ogura Y, Hayakawa M, Kanaoka N, et al. Application of three-dimensional CT angiography (3D-CTA) to cerebral aneurysms. Surg Neurol 1999;52:113-21.
• 17 Kato Y, Nair S, Sano H, Sanjaykumar MS, Katada K, Hayakawa M, et al. Multi-slice 3D-CTA - an improvement over single slice helical CTA for cerebral aneurysms. Acta Neurochir (Wien) 2002;144:715-22.
• 18 Karamessini MT, Kagadis GC, Petsas T, Karnabatidis D, Konstantinou D, Sakellaropoulos GC, et al. CT angiography with three-dimensional techniques for the early diagnosis of intracranial aneurysms. Comparison with intra-arterial DSA and the surgical findings. Eur J Radiol 2004;49:212-23.
• 19 McNamara JR, Fulton GJ, Manning BJ. Three-dimensional computed tomographic reconstruction of the carotid artery: Identifying high bifurcation. Eur J Vasc Endovasc Surg 2015;49:147-53.
• 20 Blaisdell WF, Clauss RH, Galbraith JG, Imparato AM, Wylie EJ. Joint study of extracranial arterial occlusion. IV. A review of surgical considerations. JAMA 1969;209:1889-95.
• 21 Kubota H, Sanada Y, Yoshioka H, Tasaki T, Shiroma J, Miyauchi M, et al. C1 transverse process-hyoid bone line for preoperative evaluation of the accessible internal carotid artery on carotid endarterectomy: Technical note. Acta Neurochir (Wien) 2015;157:43-8.
• 22 Kubota H, Sanada Y, Tasaki T, Miyauchi M, Tanikawa R, Ohtsuki T, et al. Surgical accessibility of the distal internal carotid artery on carotid endarterectomy evaluated using magnetic resonance angiography. Neurosurgery 2015;76:633-6.
• 23 Valenzuela S, Miralles R, Ravera MJ, Zúñiga C, Santander H, Ferrer M, et al. Does head posture have a significant effect on the hyoid bone position and sternocleidomastoid electromyographic activity in young adults? Cranio 2005;23:204-11.
• 24 Sahin Sağlam AM, Uydas NE. Relationship between head posture and hyoid position in adult females and males. J Craniomaxillofac Surg 2006;34:85-92.
• 25 Riley A, Miles A, Steele CM. An exploratory study of hyoid visibility, position, and swallowing-related displacement in a pediatric population. Dysphagia 2019;34:248-56.
• 26 Yang HM, Kim HJ, Park HW, Sohn HJ, Ok HT, Moon JH, et al. Revisiting the topographic anatomy of the marginal mandibular branch of facial nerve relating to the surgical approach. Aesthet Surg J 2016;36:977-82.
• 27 Anthony DJ, Oshan Deshanjana Basnayake BM, Mathangasinghe Y, Malalasekera AP. Preserving the marginal mandibular branch of the facial nerve during submandibular region surgery: A cadaveric safety study. Patient Saf Surg 2018;12:23.