Anatomical nuances of the internal carotid artery in relation to the quadrangular space

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  • 1 Departments of Otolaryngology–Head & Neck Surgery and
  • 2 Neurosurgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio; and
  • 3 Department of Otolaryngology–Head & Neck Surgery, Santa Casa de Misericórida de São Paulo, Brazil
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OBJECTIVE

The aim of this study was to evaluate the anatomical variations of the internal carotid artery (ICA) in relation to the quadrangular space (QS) and to propose a classification system based on the results.

METHODS

A total of 44 human cadaveric specimens were dissected endonasally under direct endoscopic visualization. During the dissection, the anatomical variations of the ICA and their relationship with the QS were noted.

RESULTS

The space between the paraclival ICAs (i.e., intercarotid space) can be classified as 1 of 3 different shapes (i.e., trapezoid, square, or hourglass) based on the trajectory of the ICAs. The ICA trajectories also directly influence the volumetric area of the QS. Based on its geometry, the QS was classified as one of the following: 1) Type A has the smallest QS area and is associated with a trapezoid intercarotid space, 2) Type B corresponds to the expected QS area (not minimized or enlarged) and is associated with a square intercarotid space, and 3) Type C has the largest QS area and is associated with an hourglass intercarotid space.

CONCLUSIONS

The different trajectories of the ICAs can modify the area of the QS and may be an essential parameter to consider for preoperative planning and defining the most appropriate corridor to reach Meckel's cave. In addition, ICA trajectories should be considered prior to surgery to avoid injuring the vessels.

ABBREVIATIONS CN = cranial nerve; CSF = cerebrospinal fluid; EEA = endoscopic endonasal approach; ICA = internal carotid artery; QS = quadrangular space.

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Contributor Notes

Correspondence Daniel M. Prevedello, Department of Neurosurgery, Wexner Medical Center at The Ohio State University, N-1049 Doan Hall, 410 West 10th Ave., Columbus, OH 43210. email: daniel.prevedello@osumc.edu.

INCLUDE WHEN CITING Published online February 24, 2017; DOI: 10.3171/2016.10.JNS16381.

Disclosures The authors report no conflict of interest concerning the materials and methods used in this study or the findings specified in this paper.

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