Surgical anatomy of the juxta—dural ring area

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  • 1 Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
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Object. The authors report on the surgical anatomy of the juxta—dural ring area of the internal carotid artery to add to the information available about this important structure.

Methods. Twenty sides of cadaver specimens were used in this study. The plane of the dural ring was found to incline in the posteromedial direction. Medial inclination was measured at 21.8° on average against the horizontal line in the anteroposterior view on radiographic studies. Posterior inclination was measured at 20.3° against the planum sphenoidale in the lateral projection, and the medial edge of the dural ring was located 0.4 mm above the tuberculum sellae in the same projection. The lateral edge of the dural ring was located 1.4 mm below the superior border of the anterior clinoid process. The carotid cave was situated at the medial or posteromedial aspect of the dural ring; however, two of the 20 specimens showed no cave formation. The carotid cave contained the subarachnoid space in 13 sides, the arachnoid membrane only in three sides, and the extraarachnoid space in two sides. The authors propose that the marker of the medial side of the dural ring, which is more proximal than the lateral, is the tuberculum sellae in the lateral view on radiographic studies. In the medial aspect of the dural ring the intradural space can be situated below the level of the tuberculum sellae because of the existence of the carotid cave.

Conclusions. An aneurysm arising from the medial side of the juxta—dural ring area even below the tuberculum sellae is a potential cause of subarachnoid hemorrhage.

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Contributor Notes

Address reprint requests to: Susumu Oikawa, M.D., Department of Neurosurgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto 390–8621, Japan.
  • 1.

    Al-Rodhan NRF, , Piepgras DG, & Sundt TM Jr: Transitional cavernous aneurysms of the internal carotid artery. Neurosurgery 33:993998, 1993 Al-Rodhan NRF, Piepgras DG, Sundt TM Jr: Transitional cavernous aneurysms of the internal carotid artery. Neurosurgery 33:993–998, 1993

    • Search Google Scholar
    • Export Citation
  • 2.

    Bouthillier A, , van Loveren HR, & Keller JT: Segments of the internal carotid artery: a new classification. Neurosurgery 38:425433, 1996 Bouthillier A, van Loveren HR, Keller JT: Segments of the internal carotid artery: a new classification. Neurosurgery 38:425–433, 1996

    • Search Google Scholar
    • Export Citation
  • 3.

    Day AL: Aneurysms of the ophthalmic segment. A clinical and anatomical analysis. J Neurosurg 72:677691, 1990 Day AL: Aneurysms of the ophthalmic segment. A clinical and anatomical analysis. J Neurosurg 72:677–691, 1990

    • Search Google Scholar
    • Export Citation
  • 4.

    Dolenc VV, Anatomy and Surgery of the Cavernous Sinus. Vienna: Springer-Verlag, 1989 Dolenc VV, Anatomy and Surgery of the Cavernous Sinus. Vienna: Springer-Verlag, 1989

    • Search Google Scholar
    • Export Citation
  • 5.

    Dolenc VV: A combined epi- and subdural direct approach to carotid-ophthalmic artery aneurysms. J Neurosurg 62:667672, 1985 Dolenc VV: A combined epi- and subdural direct approach to carotid-ophthalmic artery aneurysms. J Neurosurg 62:667–672, 1985

    • Search Google Scholar
    • Export Citation
  • 6.

    Fischer E: Die Lageabweichungen der vorderen Hirnarterie im Gefässbild. Zentralbl Neurochir 3:300313, 1938 Fischer E: Die Lageabweichungen der vorderen Hirnarterie im Gefässbild. Zentralbl Neurochir 3:300–313, 1938

    • Search Google Scholar
    • Export Citation
  • 7.

    Gibo H, , Lenkey C, & Rhoton AL Jr: Microsurgical anatomy of the supraclinoid portion of the internal carotid artery. J Neurosurg 55:560574, 1981 Gibo H, Lenkey C, Rhoton AL Jr: Microsurgical anatomy of the supraclinoid portion of the internal carotid artery. J Neurosurg 55:560–574, 1981

    • Search Google Scholar
    • Export Citation
  • 8.

    Guidetti B, & La Torre E: Management of carotid-ophthalmic aneurysms. J Neurosurg 42:438442, 1975 Guidetti B, La Torre E: Management of carotid-ophthalmic aneurysms. J Neurosurg 42:438–442, 1975

    • Search Google Scholar
    • Export Citation
  • 9.

    Inoue T, , Rhoton AL Jr, & Theele D, et al: Surgical approaches to the cavernous sinus: a microsurgical study. Neurosurgery 26:903932, 1990 Inoue T, Rhoton AL Jr, Theele D, et al: Surgical approaches to the cavernous sinus: a microsurgical study. Neurosurgery 26:903–932, 1990

    • Search Google Scholar
    • Export Citation
  • 10.

    Kobayashi S, , Kyoshima K, & Gibo H, et al: Carotid cave aneurysms of the internal carotid artery. J Neurosurg 70:216221, 1989 Kobayashi S, Kyoshima K, Gibo H, et al: Carotid cave aneurysms of the internal carotid artery. J Neurosurg 70:216–221, 1989

    • Search Google Scholar
    • Export Citation
  • 11.

    Kyoshima K, , Koike G, & Hokama M, et al: A classification of juxta-dural ring aneurysms with reference to surgical anatomy. J Clin Neurosci 3:6164, 1996 Kyoshima K, Koike G, Hokama M, et al: A classification of juxta-dural ring aneurysms with reference to surgical anatomy. J Clin Neurosci 3:61–64, 1996

    • Search Google Scholar
    • Export Citation
  • 12.

    Nutik SL: Removal of the anterior clinoid process for exposure of the proximal intracranial carotid artery. J Neurosurg 69:529534, 1988 Nutik SL: Removal of the anterior clinoid process for exposure of the proximal intracranial carotid artery. J Neurosurg 69:529–534, 1988

    • Search Google Scholar
    • Export Citation
  • 13.

    Nutik SL: Ventral paraclinoid carotid aneurysms. J Neurosurg 69:340344, 1988 Nutik SL: Ventral paraclinoid carotid aneurysms. J Neurosurg 69:340–344, 1988

    • Search Google Scholar
    • Export Citation
  • 14.

    Perneczky A, , Knosp E, & Vorkapic P, et al: Direct surgical approach to infraclinoidal aneurysms. Acta Neurochir 76:3644, 1985 Perneczky A, Knosp E, Vorkapic P, et al: Direct surgical approach to infraclinoidal aneurysms. Acta Neurochir 76:36–44, 1985

    • Search Google Scholar
    • Export Citation
  • 15.

    Punt J: Some observations on aneurysms of the proximal internal carotid artery. J Neurosurg 51:151154, 1979 Punt J: Some observations on aneurysms of the proximal internal carotid artery. J Neurosurg 51:151–154, 1979

    • Search Google Scholar
    • Export Citation
  • 16.

    Renn WH, & Rhoton AL Jr: Microsurgical anatomy of the sellar region. J Neurosurg 43:288298, 1975 Renn WH, Rhoton AL Jr: Microsurgical anatomy of the sellar region. J Neurosurg 43:288–298, 1975

    • Search Google Scholar
    • Export Citation
  • 17.

    Sadasivan B, , Ma SH, & Dujovny M, et al: The anterior cavernous sinus space. Acta Neurochir 108:154158, 1991 Sadasivan B, Ma SH, Dujovny M, et al: The anterior cavernous sinus space. Acta Neurochir 108:154–158, 1991

    • Search Google Scholar
    • Export Citation
  • 18.

    Taptas JN: Intradural and extradural ICA. J Neurosurg 51:877878, 1979 (Letter) Taptas JN: Intradural and extradural ICA. J Neurosurg 51:877–878, 1979 (Letter)

    • Search Google Scholar
    • Export Citation
  • 19.

    Umansky F, , Valarezo A, & Elidan J: The superior wall of the cavernous sinus: a microanatomical study. J Neurosurg 81:914920, 1994 Umansky F, Valarezo A, Elidan J: The superior wall of the cavernous sinus: a microanatomical study. J Neurosurg 81:914–920, 1994

    • Search Google Scholar
    • Export Citation
  • 20.

    Yaşargil MG: Microneurosurgery. Stuttgart: Thieme, 1984, Vol 2, pp 6070 Yaşargil MG: Microneurosurgery. Stuttgart: Thieme, 1984, Vol 2, pp 60–70

    • Search Google Scholar
    • Export Citation

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