• Hélène Cebula, Almaz Kurbanov, Lee A Zimmer, Pavel Poczos, James L Leach, Juan Carlos De Battista, Sébastien Froelich, Philip V Theodosopoulos, and Jeffrey T Keller.
• Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Department of Neurosurgery, Hautepierre University Hospital, Strasbourg, France.
• World Neurosurg. 2014 Dec 1;82(6):e759-64.

BackgroundClassic three-dimensional schemas of the internal carotid artery (ICA) for transcranial approaches do not necessarily apply to two-dimensional endoscopic views. Modifying an existing ICA segment classification, we define endoscopic orientation for the lacerum (C3) to clinoid (C5) segments through an endonasal approach.MethodsIn 20 cadaveric heads, we classified endoscopic appearance based on shape and angulation of C3 to C5 segments. Distances were measured between both arteries, and between the ICA and pituitary gland.ResultsWe identified 4 common ICA patterns: types I through III matched side-to-side, whereas type IV was asymmetric. In 80% of specimens, the pituitary gland had direct contact with the ICA. In 20% of specimens, a space existed between the pituitary gland and the cavernous segment. Access to the posterior aspect of the cavernous sinus medial to the cavernous segment was possible without retraction of the artery or pituitary gland. Spaces between the lacerum and cavernous segments were trapezoid (80%) and hourglass (20%).ConclusionsDistinguishing which ICA type courses between the lacerum and clinoid segments can help clarify the relationships between the artery and its surrounding structures during endoscopic approaches. Adapting the classic terminology of ICA segments provided consistency of endoscopic relevance, defined potential endoscopic corridors, and highlighted the critical step of arterial contact.Copyright © 2014. Published by Elsevier Inc.

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