Transposition of the paraclival carotid artery: a novel concept of self-retaining vascular retraction during endoscopic endonasal skull base surgery technical report.

Transposition of the paraclival carotid artery: a novel concept of self-retaining vascular retraction during endoscopic endonasal skull base surgery technical report.

Acta Neurochir (Wien). 2016 Jun 24;

Authors: Freeman JL, Sampath R, Casey MA, Quattlebaum SC, Ramakrishnan VR, Youssef AS

Abstract
BACKGROUND: Fixed retraction of the internal carotid artery (ICA) has previously been described for use during transcranial microscopic surgery. We report the novel use of a self-retaining microvascular retractor for static repositioning and protection of the ICA during expanded endonasal endoscopic approaches to the paramedian skull base.
METHODS: The transmaxillary, transpterygoid approach was performed in five cadaver heads (ten sides). The self-retaining microvascular retractor was used to laterally reposition the pterygopalatine fossa contents during exposure of the pterygoid base/plates and the paraclival ICA to expose the petrous apex. Maximum ICA retraction distance was measured in the x-axis for all ten sides.
RESULTS: The average horizontal distance of ICA retraction measured at the mid-paraclival segment for all ten sides was 4.75 mm. In all cases, the carotid artery was repositioned without injury to the vessel or disruption of the surrounding neurovascular structures.
CONCLUSIONS: Static repositioning of the ICA and other delicate neurovascular structures was effectively performed during endonasal, endoscopic cadaveric surgery of the skull base and has potential merits in live patients.

PMID: 27339269 [PubMed - as supplied by publisher]

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