The anatomy of the parapharyngeal segment of the internal carotid artery for endoscopic endonasal approach
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ORIGINAL ARTICLE
The anatomy of the parapharyngeal segment of the internal carotid artery for endoscopic endonasal approach Xinyun Fang 1
&
Guangfu Di 1 & Wei Zhou 1 & Xiaochun Jiang 1
Received: 2 April 2019 / Revised: 30 August 2019 / Accepted: 4 September 2019 # Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract Injury to the internal carotid artery (ICA) is a life-threatening complication of endoscopic endonasal approaches. The objective of this study is to illustrate the detail anatomy of the parapharyngeal segment of the ICA (PPICA) to safe endoscopic endonasal surgery. The anatomical dissection was performed in 10 cadaveric specimens and several crucial anatomical landmarks were identified and measured. In addition, 50 dry skulls were studied to further assess the relationship between the pharyngeal tubercle and carotid foramen. From the endoscopic endonasal perspective, in the median plane, the pharyngeal tubercle and the carotid foramen on both sides were located on a line. The average distance between the pharyngeal tubercle and anterior border of the external orifice of the carotid canal was measured as 25.2 ± 3.2 mm. In the paramedian plane, the PPICA was located between the levator veli palatini muscle (LVPM) and the stylopharyngeal muscle (SPM) in upper parapharyngeal space in all specimens, and the distance from the posterior border of the LVPM to the anterior border of the SPM was recorded as 15.1 ± 2.8 mm at the level of the carotid foramen. The distance from the attachment of the LVPM to the anterior border of the external orifice of the carotid canal was about 5.1 ± 0.2 mm. The fully developed stylopharyngeal fascia (SPhF) was observed in 10 cases, and the PPICA was always anteriorly enclosed by and adhered to the SPhF. Keywords Anatomy . Parapharyngeal segment of the internal carotid artery . Pharyngeal tubercle . Levator veli palatini muscle . Stylopharyngeal muscle . Stylopharyngeal fascia
Introduction Emerging technological advances in the endoscopic endonasal approach have facilitated direct visualization and access to target lesions at the ventral cranial base. Consequently, surgeries of the lower third of the clivus, foramen magnum, craniocervical junction, odontoid process, inferior petroclival, medial occipital condyle, hypoglossal canal, and jugular foramen are increasingly conducted endoscopically [1, 3, 10, 17, 24, 25]. Nevertheless, complications attributable to these approaches have increased proportionally [11, 14]. One of the most serious complications is an injury to the internal carotid artery [7], as the two parapharyngeal segments of the internal carotid artery (PPICA) form * Xiaochun Jiang [email protected] 1
Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, No. 2 Zheshan west road, Wuhu, China
the lateral boundaries of these areas. Furthermore, there is a lack of clearly recognizable landmarks for the PPICA which is surrounded by soft tissue, compared with other ICA segments with their fixed position in the bony canals and distinct
