• Zhechen Li, Qingcong Zheng, Yaowang Pan, Zhibin Chen, and Weihong Xu.
• Department of Spine Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Orthopedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
• World Neurosurg. 2024 Sep 12.

ObjectiveTo evaluate internal carotid artery's (ICA) anatomical relationships with atlantoaxial joints and posterior pharyngeal wall and to illustrate ICA injury risk during transoral procedures to the upper cervical spine.MethodsCervical spine computed tomography angiography of 238 patients was retrospectively evaluated. Each ICA was classified into 1 of 3 zones: areas medial (Zone 1), anterior (Zone 2), or lateral (Zone 3) to the atlantoaxial joint. For an ICA in Zone 1, the shortest distances to the posterior pharyngeal wall and midsagittal plane were measured. For an ICA in Zone 2, the closest distances to the midsagittal plane and anterior cortex of the C1-2 complex were measured.ResultsFifteen ICAs in Zone 1 were found in 12 (5%) patients, with 3 female patients having bilateral ICAs medial to the atlantoaxial joint. The incidence of ICA in Zone 1 was higher in females than in males. In cases of ICAs in Zone 2, the ICAs were close to the anterior cortex of the C1-2 complex, with the shortest distance being 2.6 ± 1.5 mm. A total of 39.9% of patients had bilateral ICAs in Zone 3.ConclusionsTransoral surgeries in the upper cervical spine carry potential ICA injury risk. They should be carefully deliberated in patients whose ICAs are in Zone 1. In cases of ICAs in Zone 2, meticulous subperiosteal stripping and gentle traction should be performed on the posterior pharyngeal wall. Preoperative identification of the course of ICAs is mandatory in patients undergoing transoral surgeries in the upper cervical spine.Copyright © 2024 Elsevier Inc. All rights reserved.

5 keywords...

hide…