CLINICAL BASIS FOR THE KNOWLEDGE OF ANATOMY OF THE CAROTID ARTERY: A REVIEW ARTICLE (original) (raw)
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Neurologia medico-chirurgica, 2005
The nomenclature and borders of the segments of the internal carotid artery (ICA) remain confusing. A classification of segments of the ICA is proposed based on constant anatomical structures, such as the carotid foramen and canal, the petrous bone, the petrolingual ligament (PLL), and the proximal and distal dural rings. The bilateral ICAs were dissected in 15 cadaveric head specimens using different neurosurgical approaches. The bilateral lacerum foramina were studied in five dry skulls. The bilateral segments of the ICA were also examined on carotid angiograms of 10 normal patients and another with the ophthalmic artery originating from the intracavernous portion of the ICA. The present classification divides the ICA into five segments in the direction of the blood flow. The cervical segment is extradural and extracranial, the petrous segment is extradural and intraosseous, the cavernous segment is interdural and intracavernous, the clinoidal segment is interdural and paracavernous, and the cisternal segment is intradural and intracisternal. The ICA did not pass through the lacerum foramen in any specimen. In all specimens, 1/8 to 5/8 of the lacerum foramen was under the deep dural layer of the cavernous sinus. The term`lacerum segment' as used previously and called the`trigeminal segment' by us cannot be justified. The PLL is the posterolateral border of the cavernous sinus and the lacerum and trigeminal segments should be included in the cavernous and petrous segments. The ophthalmic artery may originate from the clinoidal ICA, from the cavernous ICA, or from the middle meningeal artery. Instead of using the term`ophthalmic segment,' the term`cisternal segment' should be used for the anatomically distinct ICA in the subarachnoid space. This classification should be minimally affected by anatomical variations.
Background & Aim: Anyone practising surgery or medicine should have a firm grasp on the regular anatomy of ECA and its variants, as well as its branches. Both carotid endarterectomy and carotid stenting, which are used to prevent recurrent strokes, necessitate in-depth familiarity with the carotid system. The aim of the present study was to study the relationship of External Carotid Artery with reference to Adjacent Anatomical landmarks in cadavers. Methods: The present prospective study was done in the Department of Anatomy, RMCRC, Rama University, Kanpur, UP, India, over a period of 1.5 years after obtaining clearance from the institutional ethical clearance committee. 30 hemi-necks obtained from 15 formalin embalmed cadavers (10 male and 5 female) were dissected and the external carotid arteries were traced from the origin to termination. Results: The ECA took origin at the level of upper border of thyroid cartilage (TC) in 20/30 cases (66.66%). Higher level of origin was noted in the remaining 10 of 30 cases (33.34%). Higher levels of carotid bifurcation were further categorized keeping the TC as anatomical landmark. No lower levels of origin were noted in this study. The anteromedial position of the ECA relative to the ICA at the level of the carotid bifurcation was noted in all the cases. Conclusion: The anatomical knowledge of relationship of External Carotid Artery with reference to adjacent anatomical landmarks is helpful for vascular surgeons to plan surgeries and prevent complications during various diagnostic and therapeutic procedures.
Surgical and Radiologic Anatomy
Anatomical variations of the internal carotid artery (ICA) can cause complications during endovascular treatments. Therefore, the aim of this study was to investigate the features of the ICAs obtained from 2D digital subtraction angiography (2D DSA). Methods The morphometrics and angles of the ICA segments from 2D DSA images from a total of 100 patients (45 males and 55 females) were investigated. The lengths (L1-3), angles (A1-3), and diameters (D1-6) through the ICA measurement points (5 segments: C2 [petrous], C3 [lacerum], C4 [cavernous], C5 [clinoid], C6 (ophthalmic] were systemically recorded by two observers. All measured parameters were compared for both sexes and sides. Results The lengths (mm) and angles of the ICA were 7.20 ± 2.22 (L1), 15.71 ± 2.32 (L2), 10.99 ± 1.66 (L3) and 109.31 ± 17.77 (A1), 107.87 ± 20.51 (A2), 80.81 ± 16.33 (A3), respectively. There were no differences in the angulations of the A1-A3 segments between the sexes (p > 0.05). The L2 (C3-C4) was signi cantly longer in males, but only the left side of females showed a greater length (p < 0.05). The averaged mean diameters of the ICA (D1-6) in both sexes were 4.17 ± 0.55 mm. However, the diameters of the D1-D6 from left and right sides of males except the right D6 were signi cantly longer than those of females (p < 0.05). Also of signi cance was that the right diameters of females (D1) and males (D1 and D2) were shorter compared to left sides. Conclusion This study demonstrates some differences in lengths, diameters, and angles in both sexes and sides of the normal ICA. Neurosurgeons and neurointerventionalists should be aware of such variations when operating, performing interventional procedures, and interpreting 2D DSA.
Internal carotid artery: correlative anatomy as a guide to surgery
International Congress Series, 2002
The course of the internal carotid artery (ICA), particularly the C4 -C6 segments, cavernous, clinoid, and ophthalmic, respectively, as described by Bouthillier et al. traverses a relatively compact region of complex anatomical relationships. The bony, dural, connective tissue, and neurovascular elements of this region frequently deter access or ''block'' surgical entry. The key to unlocking this region is a detailed understanding of its surgical anatomy. The treatment of aneurysms in proximity to the distal dural ring (DDR), e.g. clinoid, superior hypophyseal, or carotid ophthalmic aneurysms, presents considerable challenges to the neurosurgeon. The anterior clinoid process (ACP) and its associated anatomical variations, including a prominent middle clinoid process (MCP) and aerated optic strut, must be considered and anticipated when performing an anterior clinoidectomy. Aneurysms of the C4 -C6 segments can transgress either the proximal or distal dural rings or both; this transgression (so-called transitional aneurysms) can occur in either direction making an extradural aneurysm and also intradural or vice versa. The existence of a carotid cave as originally described by Kobayashi et al. must be taken into consideration in the analysis of aneurysms of the ICA in proximity to the DDR. Again, determination of the relationship of the aneurysm to the DDR is critical to the decision making process; extradural aneurysms have a considerably different prognosis and treatment than intradural aneurysms. The correlation of cadaveric anatomy to surgical anatomy will serve as a guide to improve surgical techniques, strategies, and outcome. D
Indian Journal of Clinical Anatomy and Physiology
Background: Internal carotid artery (ICA) is a major source of blood supply to the brain. Awareness of the petrous and cavernous parts of ICA is significant for radiological diagnosis and surgical interventions on skull base. Though several angiographic studies and few endoscopic skull base studies have been done on the artery, there are very few cadaveric dissection studies available in the literature on both the parts. Aims: To study the morphology and morphometry of the petrous and cavernous parts of the ICA. Materials and Methods: The study was conducted on fifty, formalin fixed head and neck specimens in the
Neurosurgical review, 2018
The course of the internal carotid artery (ICA) and its segment classifications were reviewed by means of a new and freely available 3D interactive model of the artery and the skull base, based on human neuroimages, that can be freely downloaded at the Public Repository of the University of Barcelona ( http://diposit.ub.edu/dspace/handle/2445/112442 ) and runs under Acrobat Reader in Mac and Windows computers and Windows 10 tablets. The 3D-PDF allows zoom, rotation, selective visualization of structures, and a predefined sequence view. Illustrative images of the different classifications were obtained. Fischer (Zentralbl Neurochir 3:300-313, 1938) described five segments in the opposite direction to the blood flow. Gibo-Rothon (J Neurosurg 55:560-574, 1981) follow the blood flow, incorporated the cervical and petrous portions, and divided the subarachnoid course-supraclinoid-in ophthalmic, communicating, and choroidal segments, enhancing transcranial microscopic approaches. Bouthill...
Study of Variations of Cervical Segment of Internal Carotid Artery
Journal of Anatomical Sciences
Introduction: Presence of variations in the course of the cervical (extracranial) part of the internal carotid artery (I.C.A.) in the form of tortuosity, kinking, coiling or looping is a rare condition. These may be attributed to embryological or acquired factors. Patients with such variations may be asymptomatic in some cases, whereas, they may develop cerebrovascular symptoms due to carotid stenosis affecting cerebral circulation. Materials and methods: The present study was performed during routine undergraduate dissection classes in total 21 human cadavers (6 females and 15 males) on bilateral sides. Results: Bilateral kinking and looping of the cervical part of the I.C.A. was found in two cadavers. Conclusions: The risk of transient ischemic attacks (TIA) in patients with carotid stenosis is high and surgical correction is indicated as a part of treatment. Further, patients having these variations are more prone to injury during radical neck dissection and other surgical operat...
Cureus
Introduction: The prime source of vascularization to the head and neck region is through the carotid arteries. The terminal branches of common carotid arteries, such as external carotid artery (ECA) and internal carotid artery (ICA), and their branches are crucial due to the wide area of distribution and variations in their branching pattern. The branching pattern and morphometry are essential for surgeons in the planning and execution of head and neck surgeries. Therefore, this study was conducted to observe the branching patterns of ECA and analyze them morphometrically. Materials and methods: This retrospective study includes 100 CT images, inclusive of 32 females and 68 males. The branching pattern and luminal diameter of CCA and ECA were measured and analyzed statistically. Results: The luminal diameter of CCA in males were as follows: 7.4 ± 1.01 (R), 7.1 ± 0.8 (L), and in females: 7.3 ± 0.9 (R), 7 ± 0.9mm (L); and the luminal diameter of ECA in males: 5.2 ± 1.0mm (R), 5.2 ± 0.9mm (L), and in females: 5.0 ± 0.9mm (R), 5.1 ± 1.0mm (L). The level of the carotid bifurcation and ECA branching pattern was observed, and variations were commonly seen in the superior thyroid artery (STA), lingual artery (LA), and facial artery (FA). Conclusion: The findings of the present study with regard to the external carotid artery and its branching pattern correlate with previous studies. The most common variations were observed in the superior thyroid and lingual and facial arteries. Knowledge about the morphology and branching pattern of the carotid artery is essential for procedures such as intra-arterial chemotherapy, carotid artery stenting, endarterectomy, and extra-intra cranial bypass revascularization procedure where it is harvested as a donor's vessel.