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Intracranial Segment

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Surgical Anatomy of the Internal Carotid Artery

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Abstract

Above the petrolingual ligament, the internal carotid artery (ICA) can be considered to be intracavernous. From an endoscopic anterior viewpoint, we can define a paraclival and a parasellar segment, especially evident in well-pneumatised sphenoid sinuses. The paraclival segment corresponds to the vertical segment of the ICAc (cavernous portion of the ICA). Endoscopically speaking, this portion of the vessel represents the lateral border of the clival window. Although some authors have divided the paraclival portion in subsegments (Herzallah and Casiano 2007), we do not consider this further classification as having surgical utility. At a variable distance from the posterior clinoid process, the vertical segment—paraclival—bends forward, forming the posterior bend of the ICAc. Then, the artery usually runs horizontally for a short distance (horizontal segment) and curves upward, thus giving the anterior bend that reaches the anterior clinoid process. For this reason, the cavernous portion in the typical neurosurgical literature has been divided into five segments: posterior vertical, posterior bend, horizontal, anterior bend, and anterior vertical (Inoue et al. 1990). It must be underlined that the configuration of the posterior bend varies significantly, and that sometimes it can bulge upward into and deform the dura of the cavernous sinus (CS) roof just lateral to the posterior clinoid process. The last segment, the anterior vertical, also named the clinoid or paraclinoid, is not completely intracavernous, but in “endoscopic” practice, it can be considered so; for this reason, we have included it in this section.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy

    Paolo Castelnuovo & Iacopo Dallan

  2. Medical University of Vienna, Vienna, Austria

    Manfred Tschabitscher

Authors
  1. Paolo Castelnuovo
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  2. Iacopo Dallan
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  3. Manfred Tschabitscher
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Castelnuovo, P., Dallan, I., Tschabitscher, M. (2013). Intracranial Segment. In: Surgical Anatomy of the Internal Carotid Artery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-29664-2_3

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  • DOI: https://doi.org/10.1007/978-3-642-29664-2_3

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  • Print ISBN: 978-3-642-29663-5

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