Finding the Petroclival Carotid Artery

The Vidian–Eustachian Junction as a Reliable Landmark

Gretchen M. Oakley, Jareen Ebenezer, Aneeza Khairiyah Wan Hamizan, Peta Lee Sacks, Darren Rom, Raymond Sacks, Mark Winder, Andrew Davidson, Charles Teo, Arturo A. Solares, Richard J. Harvey

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Introduction Identifying the internal carotid artery (ICA) when managing petroclival and infratemporal fossa pathology is essential for the skull base surgeon. The vidian nerve and eustachian tube (ET) cartilage come together at the foramen lacerum, the vidian–eustachian junction (VEJ). The ICA position, relative to the VEJ is described. Methods Endoscopic dissection of adult fresh-frozen cadaver ICAs and a case series of patients with petroclival pathology were performed. The relationship of the VEJ to the ICA horizontal segment, vertical segment, and second genu was assessed. The distance of the ICA second genu to VEJ was determined in coronal, axial, and sagittal planes. The length of the vidian nerve and ET was measured from the pterygopalatine fossa (PPF) and nasopharyngeal orifice to the VEJ. Results In this study, 10 cadaver dissections (82.3 ± 6.7 years, 40% female) were performed. The horizontal petrous ICA was at or behind VEJ in 100%, above VEJ in 100%, and lateral to VEJ in 80%. The vertical paraclival segment was at or behind VEJ in 100%, above in 100%, and medial in 100%. The second genu was at or behind VEJ in 100% (3.3 ± 2.4 mm), at or above in 100% (2.5 ± 1.6 mm), and medial in 100% (3.4 ± 2.0 mm). The VEJ was successfully used to locate the ICA in nine consecutive patients (53.3 ± 13.6 years, 55.6% female) where pathology was also present. The VEJ was 15.0 ± 6.0 mm from the ET and 17.4 ± 4.1 mm from the PPF. Conclusion The VEJ is an excellent landmark as it defines both superior and posterior limits when isolating the ICA in skull base surgery.

Original languageEnglish
JournalJournal of Neurological Surgery, Part B: Skull Base
DOIs
Publication statusAccepted/In press - 27 Nov 2017

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Internal Carotid Artery
Carotid Arteries
Eustachian Tube
Pterygopalatine Fossa
Skull Base
Pathology
Cadaver
Dissection
Cartilage

Keywords

  • anatomy
  • endoscopic surgery
  • eustachian tube
  • internal carotid artery
  • skull base
  • vidian nerve

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Finding the Petroclival Carotid Artery : The Vidian–Eustachian Junction as a Reliable Landmark. / Oakley, Gretchen M.; Ebenezer, Jareen; Wan Hamizan, Aneeza Khairiyah; Sacks, Peta Lee; Rom, Darren; Sacks, Raymond; Winder, Mark; Davidson, Andrew; Teo, Charles; Solares, Arturo A.; Harvey, Richard J.

In: Journal of Neurological Surgery, Part B: Skull Base, 27.11.2017.

Research output: Contribution to journalArticle

Oakley, Gretchen M. ; Ebenezer, Jareen ; Wan Hamizan, Aneeza Khairiyah ; Sacks, Peta Lee ; Rom, Darren ; Sacks, Raymond ; Winder, Mark ; Davidson, Andrew ; Teo, Charles ; Solares, Arturo A. ; Harvey, Richard J. / Finding the Petroclival Carotid Artery : The Vidian–Eustachian Junction as a Reliable Landmark. In: Journal of Neurological Surgery, Part B: Skull Base. 2017.
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title = "Finding the Petroclival Carotid Artery: The Vidian–Eustachian Junction as a Reliable Landmark",
abstract = "Introduction Identifying the internal carotid artery (ICA) when managing petroclival and infratemporal fossa pathology is essential for the skull base surgeon. The vidian nerve and eustachian tube (ET) cartilage come together at the foramen lacerum, the vidian–eustachian junction (VEJ). The ICA position, relative to the VEJ is described. Methods Endoscopic dissection of adult fresh-frozen cadaver ICAs and a case series of patients with petroclival pathology were performed. The relationship of the VEJ to the ICA horizontal segment, vertical segment, and second genu was assessed. The distance of the ICA second genu to VEJ was determined in coronal, axial, and sagittal planes. The length of the vidian nerve and ET was measured from the pterygopalatine fossa (PPF) and nasopharyngeal orifice to the VEJ. Results In this study, 10 cadaver dissections (82.3 ± 6.7 years, 40{\%} female) were performed. The horizontal petrous ICA was at or behind VEJ in 100{\%}, above VEJ in 100{\%}, and lateral to VEJ in 80{\%}. The vertical paraclival segment was at or behind VEJ in 100{\%}, above in 100{\%}, and medial in 100{\%}. The second genu was at or behind VEJ in 100{\%} (3.3 ± 2.4 mm), at or above in 100{\%} (2.5 ± 1.6 mm), and medial in 100{\%} (3.4 ± 2.0 mm). The VEJ was successfully used to locate the ICA in nine consecutive patients (53.3 ± 13.6 years, 55.6{\%} female) where pathology was also present. The VEJ was 15.0 ± 6.0 mm from the ET and 17.4 ± 4.1 mm from the PPF. Conclusion The VEJ is an excellent landmark as it defines both superior and posterior limits when isolating the ICA in skull base surgery.",
keywords = "anatomy, endoscopic surgery, eustachian tube, internal carotid artery, skull base, vidian nerve",
author = "Oakley, {Gretchen M.} and Jareen Ebenezer and {Wan Hamizan}, {Aneeza Khairiyah} and Sacks, {Peta Lee} and Darren Rom and Raymond Sacks and Mark Winder and Andrew Davidson and Charles Teo and Solares, {Arturo A.} and Harvey, {Richard J.}",
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T2 - The Vidian–Eustachian Junction as a Reliable Landmark

AU - Oakley, Gretchen M.

AU - Ebenezer, Jareen

AU - Wan Hamizan, Aneeza Khairiyah

AU - Sacks, Peta Lee

AU - Rom, Darren

AU - Sacks, Raymond

AU - Winder, Mark

AU - Davidson, Andrew

AU - Teo, Charles

AU - Solares, Arturo A.

AU - Harvey, Richard J.

PY - 2017/11/27

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N2 - Introduction Identifying the internal carotid artery (ICA) when managing petroclival and infratemporal fossa pathology is essential for the skull base surgeon. The vidian nerve and eustachian tube (ET) cartilage come together at the foramen lacerum, the vidian–eustachian junction (VEJ). The ICA position, relative to the VEJ is described. Methods Endoscopic dissection of adult fresh-frozen cadaver ICAs and a case series of patients with petroclival pathology were performed. The relationship of the VEJ to the ICA horizontal segment, vertical segment, and second genu was assessed. The distance of the ICA second genu to VEJ was determined in coronal, axial, and sagittal planes. The length of the vidian nerve and ET was measured from the pterygopalatine fossa (PPF) and nasopharyngeal orifice to the VEJ. Results In this study, 10 cadaver dissections (82.3 ± 6.7 years, 40% female) were performed. The horizontal petrous ICA was at or behind VEJ in 100%, above VEJ in 100%, and lateral to VEJ in 80%. The vertical paraclival segment was at or behind VEJ in 100%, above in 100%, and medial in 100%. The second genu was at or behind VEJ in 100% (3.3 ± 2.4 mm), at or above in 100% (2.5 ± 1.6 mm), and medial in 100% (3.4 ± 2.0 mm). The VEJ was successfully used to locate the ICA in nine consecutive patients (53.3 ± 13.6 years, 55.6% female) where pathology was also present. The VEJ was 15.0 ± 6.0 mm from the ET and 17.4 ± 4.1 mm from the PPF. Conclusion The VEJ is an excellent landmark as it defines both superior and posterior limits when isolating the ICA in skull base surgery.

AB - Introduction Identifying the internal carotid artery (ICA) when managing petroclival and infratemporal fossa pathology is essential for the skull base surgeon. The vidian nerve and eustachian tube (ET) cartilage come together at the foramen lacerum, the vidian–eustachian junction (VEJ). The ICA position, relative to the VEJ is described. Methods Endoscopic dissection of adult fresh-frozen cadaver ICAs and a case series of patients with petroclival pathology were performed. The relationship of the VEJ to the ICA horizontal segment, vertical segment, and second genu was assessed. The distance of the ICA second genu to VEJ was determined in coronal, axial, and sagittal planes. The length of the vidian nerve and ET was measured from the pterygopalatine fossa (PPF) and nasopharyngeal orifice to the VEJ. Results In this study, 10 cadaver dissections (82.3 ± 6.7 years, 40% female) were performed. The horizontal petrous ICA was at or behind VEJ in 100%, above VEJ in 100%, and lateral to VEJ in 80%. The vertical paraclival segment was at or behind VEJ in 100%, above in 100%, and medial in 100%. The second genu was at or behind VEJ in 100% (3.3 ± 2.4 mm), at or above in 100% (2.5 ± 1.6 mm), and medial in 100% (3.4 ± 2.0 mm). The VEJ was successfully used to locate the ICA in nine consecutive patients (53.3 ± 13.6 years, 55.6% female) where pathology was also present. The VEJ was 15.0 ± 6.0 mm from the ET and 17.4 ± 4.1 mm from the PPF. Conclusion The VEJ is an excellent landmark as it defines both superior and posterior limits when isolating the ICA in skull base surgery.

KW - anatomy

KW - endoscopic surgery

KW - eustachian tube

KW - internal carotid artery

KW - skull base

KW - vidian nerve

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