Proposed clinical internal carotid artery classification system
Introduction: Numerical classification systems for the internal carotid artery (ICA) are available, but modifications have added confusion to the numerical systems. Furthermore, previous classifications may not be applicable uniformly to microsurgical and endoscopic procedures. The purpose of this s...
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2016-01-01
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| Series: | Journal of Craniovertebral Junction and Spine |
| Subjects: | |
| Online Access: | http://www.jcvjs.com/article.asp?issn=0974-8237;year=2016;volume=7;issue=3;spage=161;epage=170;aulast=Abdulrauf |
| _version_ | 1818054699397414912 |
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| author | Saleem I Abdulrauf Ahmed M Ashour Eric Marvin Jeroen Coppens Brian Kang Tze Yu Yeh Hsieh Breno Nery Juan R Penanes Aysha K Alsahlawi Shawn Moore Hussam Abou Al-Shaar Joanna Kemp Kanika Chawla Nanthiya Sujijantarat Alaa Najeeb Nadeem Parkar Vilaas Shetty Tina Vafaie Jastin Antisdel Tony A Mikulec Randall Edgell Jonathan Lebovitz Matt Pierson Paulo Henrique Pires de Aguiar Paula Buchanan Angela Di Cosola George Stevens |
| author_facet | Saleem I Abdulrauf Ahmed M Ashour Eric Marvin Jeroen Coppens Brian Kang Tze Yu Yeh Hsieh Breno Nery Juan R Penanes Aysha K Alsahlawi Shawn Moore Hussam Abou Al-Shaar Joanna Kemp Kanika Chawla Nanthiya Sujijantarat Alaa Najeeb Nadeem Parkar Vilaas Shetty Tina Vafaie Jastin Antisdel Tony A Mikulec Randall Edgell Jonathan Lebovitz Matt Pierson Paulo Henrique Pires de Aguiar Paula Buchanan Angela Di Cosola George Stevens |
| author_sort | Saleem I Abdulrauf |
| collection | DOAJ |
| description | Introduction: Numerical classification systems for the internal carotid artery (ICA) are available, but modifications have added confusion to the numerical systems. Furthermore, previous classifications may not be applicable uniformly to microsurgical and endoscopic procedures. The purpose of this study was to develop a clinically useful classification system.
Materials and Methods: We performed cadaver dissections of the ICA in 5 heads (10 sides) and evaluated 648 internal carotid arteries with computed tomography angiography. We identified specific anatomic landmarks to define the beginning and end of each ICA segment.
Results: The ICA was classified into eight segments based on the cadaver and imaging findings: (1) Cervical segment; (2) cochlear segment (ascending segment of the ICA in the temporal bone) (relation of the start of this segment to the base of the styloid process: Above, 425 sides [80%]; below, 2 sides [0.4%]; at same level, 107 sides [20%];P< 0.0001) (relation of cochlea to ICA: Posterior, 501 sides [85%]; posteromedial, 84 sides [14%];P< 0.0001); (3) petrous segment (horizontal segment of ICA in the temporal bone) starting at the crossing of the eustachian tube superolateral to the ICA turn in all 10 samples; (4) Gasserian-Clival segment (ascending segment of ICA in the cavernous sinus) starting at the petrolingual ligament (PLL) (relation to vidian canal on imaging: At same level, 360 sides [63%]; below, 154 sides [27%]; above, 53 sides [9%];P< 0.0001); in this segment, the ICA projected medially toward the clivus in 275 sides (52%) or parallel to the clivus with no deviation in 256 sides (48%;P< 0.0001); (5) sellar segment (medial loop of ICA in the cavernous sinus) starting at the takeoff of the meningeal hypophyseal trunk (ICA was medial into the sella in 271 cases [46%], lateral without touching the sella in 127 cases [23%], and abutting the sella in 182 cases [31%];P< 0.0001); (6) sphenoid segment (lateral loop of ICA within the cavernous sinus) starting at the crossing of the fourth cranial nerve on the lateral aspect of the cavernous ICA and located directly lateral to the sphenoid sinus; (7) ring segment (ICA between the 2 dural rings) starting at the crossing of the third cranial nerve on the lateral aspect of the ICA; (8) cisternal segment starting at the distal dural ring.
Conclusions: The classification may be applied uniformly to all skull base surgical approaches including lateral microsurgical and ventral endoscopic approaches, obviating the need for 2 separate classification systems. The classification allows extrapolation of relevant clinical information because each named segment may indicate potential surgical risk to specific structures. |
| first_indexed | 2024-12-10T12:01:12Z |
| format | Article |
| id | doaj.art-ad68379fc3474f83a2255b5c09bb53a3 |
| institution | Directory Open Access Journal |
| issn | 0974-8237 |
| language | English |
| last_indexed | 2024-12-10T12:01:12Z |
| publishDate | 2016-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Craniovertebral Junction and Spine |
| spelling | doaj.art-ad68379fc3474f83a2255b5c09bb53a32022-12-22T01:49:38ZengWolters Kluwer Medknow PublicationsJournal of Craniovertebral Junction and Spine0974-82372016-01-017316117010.4103/0974-8237.188412Proposed clinical internal carotid artery classification systemSaleem I AbdulraufAhmed M AshourEric MarvinJeroen CoppensBrian KangTze Yu Yeh HsiehBreno NeryJuan R PenanesAysha K AlsahlawiShawn MooreHussam Abou Al-ShaarJoanna KempKanika ChawlaNanthiya SujijantaratAlaa NajeebNadeem ParkarVilaas ShettyTina VafaieJastin AntisdelTony A MikulecRandall EdgellJonathan LebovitzMatt PiersonPaulo Henrique Pires de AguiarPaula BuchananAngela Di CosolaGeorge StevensIntroduction: Numerical classification systems for the internal carotid artery (ICA) are available, but modifications have added confusion to the numerical systems. Furthermore, previous classifications may not be applicable uniformly to microsurgical and endoscopic procedures. The purpose of this study was to develop a clinically useful classification system. Materials and Methods: We performed cadaver dissections of the ICA in 5 heads (10 sides) and evaluated 648 internal carotid arteries with computed tomography angiography. We identified specific anatomic landmarks to define the beginning and end of each ICA segment. Results: The ICA was classified into eight segments based on the cadaver and imaging findings: (1) Cervical segment; (2) cochlear segment (ascending segment of the ICA in the temporal bone) (relation of the start of this segment to the base of the styloid process: Above, 425 sides [80%]; below, 2 sides [0.4%]; at same level, 107 sides [20%];P< 0.0001) (relation of cochlea to ICA: Posterior, 501 sides [85%]; posteromedial, 84 sides [14%];P< 0.0001); (3) petrous segment (horizontal segment of ICA in the temporal bone) starting at the crossing of the eustachian tube superolateral to the ICA turn in all 10 samples; (4) Gasserian-Clival segment (ascending segment of ICA in the cavernous sinus) starting at the petrolingual ligament (PLL) (relation to vidian canal on imaging: At same level, 360 sides [63%]; below, 154 sides [27%]; above, 53 sides [9%];P< 0.0001); in this segment, the ICA projected medially toward the clivus in 275 sides (52%) or parallel to the clivus with no deviation in 256 sides (48%;P< 0.0001); (5) sellar segment (medial loop of ICA in the cavernous sinus) starting at the takeoff of the meningeal hypophyseal trunk (ICA was medial into the sella in 271 cases [46%], lateral without touching the sella in 127 cases [23%], and abutting the sella in 182 cases [31%];P< 0.0001); (6) sphenoid segment (lateral loop of ICA within the cavernous sinus) starting at the crossing of the fourth cranial nerve on the lateral aspect of the cavernous ICA and located directly lateral to the sphenoid sinus; (7) ring segment (ICA between the 2 dural rings) starting at the crossing of the third cranial nerve on the lateral aspect of the ICA; (8) cisternal segment starting at the distal dural ring. Conclusions: The classification may be applied uniformly to all skull base surgical approaches including lateral microsurgical and ventral endoscopic approaches, obviating the need for 2 separate classification systems. The classification allows extrapolation of relevant clinical information because each named segment may indicate potential surgical risk to specific structures.http://www.jcvjs.com/article.asp?issn=0974-8237;year=2016;volume=7;issue=3;spage=161;epage=170;aulast=AbdulraufAneurysms; endoscopy; internal carotid artery skull base; tumors. |
| spellingShingle | Saleem I Abdulrauf Ahmed M Ashour Eric Marvin Jeroen Coppens Brian Kang Tze Yu Yeh Hsieh Breno Nery Juan R Penanes Aysha K Alsahlawi Shawn Moore Hussam Abou Al-Shaar Joanna Kemp Kanika Chawla Nanthiya Sujijantarat Alaa Najeeb Nadeem Parkar Vilaas Shetty Tina Vafaie Jastin Antisdel Tony A Mikulec Randall Edgell Jonathan Lebovitz Matt Pierson Paulo Henrique Pires de Aguiar Paula Buchanan Angela Di Cosola George Stevens Proposed clinical internal carotid artery classification system Journal of Craniovertebral Junction and Spine Aneurysms; endoscopy; internal carotid artery skull base; tumors. |
| title | Proposed clinical internal carotid artery classification system |
| title_full | Proposed clinical internal carotid artery classification system |
| title_fullStr | Proposed clinical internal carotid artery classification system |
| title_full_unstemmed | Proposed clinical internal carotid artery classification system |
| title_short | Proposed clinical internal carotid artery classification system |
| title_sort | proposed clinical internal carotid artery classification system |
| topic | Aneurysms; endoscopy; internal carotid artery skull base; tumors. |
| url | http://www.jcvjs.com/article.asp?issn=0974-8237;year=2016;volume=7;issue=3;spage=161;epage=170;aulast=Abdulrauf |
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