Childs Nerv Syst DOI 10.1007/s00381-015-2674-x
ORIGINAL PAPER
Analysis of the tortuosity of the internal carotid artery in the cavernous sinus Christoph J. Griessenauer & Bulent Yalcin & Petru Matusz & Marios Loukas & Charles G. Kulwin & R. Shane Tubbs & Aaron A. Cohen Gadol
Received: 21 February 2015 / Accepted: 25 February 2015 # Springer-Verlag Berlin Heidelberg 2015
Abstract Background The morphology of the internal carotid artery at the skull base is important in radiologic interpretation, surgery, and more recently, endovascular interventional and diagnostic procedures. Therefore, a thorough knowledge of the shape of the carotid siphon can be important in the clinical realm. Methods In this study, we evaluated the shape of the carotid siphon from a lateral perspective on cerebral angiography. These shapes were then correlated to the Lang and Reiter classification. Results Types A, B, and C were distributed as follows: type A 12 (30 %), B 16 (40 %), 12 (30 %). There was no significant difference (p>0.05) in patient ages between the three types (type A 54.6±14.2 years, type B 55.1±14.9 years, and type C 52.7±16.9 years). Normalized for gender disproportion, there was no significant gender predominance for any type (type A female:male=1.4:1; type B female:male=1.1:1; type C female:male=0.7:1). C. J. Griessenauer : R. S. Tubbs (*) Pediatric Neurosurgery, Children’s of Alabama, Birmingham, AL, USA e-mail: [email protected] B. Yalcin Department of Anatomy, Gulhane Military Medical Academy, Ankara, Turkey P. Matusz Department of Anatomy, BVictor Babes^ University of Medicine and Pharmacy, Timisoara, Romania M. Loukas Department of Anatomical Sciences, St. George’s University, St. George, Grenada C. G. Kulwin : A. A. C. Gadol Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
Conclusions Such a classification scheme with additional application in another group might be of use to future studies aimed at the morphology of the cavernous part of the internal carotid artery. Keywords Anatomy . Skull base . Internal carotid . Artery . Surgery . Radiology
Introduction The cavernous sinuses are located on each side of the body of the sphenoid and have spatial relationships with the internal carotid artery (ICA), cranial nerves III, IV, V1, V2, VI, and the pituitary gland [1]. Therefore, this region is an area of interest to endocrinologists, neurologists, neurosurgeons, ophthalmologists, and otolaryngologists alike. The sinuses anastomose with each other through the intercavernous sinuses and the paired ICAs also contain extensive anastomoses [2]. The intracavernous portion of the internal carotid artery (cICA) is often referred to as the carotid siphon due to its double-bend morphology. The cICA extends from the superior border of the petrolingual ligament to the proximal dural ring and contains along its course from proximal to distal a posterior vertical segment, posterior bend, horizontal segment, anterior bend, and finally, an anterior vertical segment as it leaves the cavernous sinus and enters the subarachnoid space medial to the anterior clinoid process [3, 4]. Ziyal et al. [5] in 2005 further classified this segment of the ICA as being intradural and intracavernous. Although on average less than 2 cm long, the morphology of the cICA is very complex. This segment of the artery contains extensive fine branching with the two most common branches being the meningohypophyseal
Childs Nerv Syst
trunk (MHT) and the inferolateral trunk (ILT), also called artery of the inferior cavernous sinus. These typically branch off from the middle of the convex outer margin of the posterior bend and the central third of the inferolateral surface of the horizontal segment respectively [6]. In addition to variants of the branching pattern, the cICA may be curved at different angles along the two bends described earlier and coiled along its course. In this paper, we will refer to the combination of bending and coiling as the tortuosity of the vessel, investigate various attempts to classify tortuosity of the cICA, and focus on the clinical relevance of such classification.
Results Types A, B, and C were distributed as follows: type A 12 (30 %), B 16 (40 %), 12 (30 %) (Fig. 2). There was no significant difference (p>0.05) in patient ages between the 3 types (type A 54.6±14.2 years; type B 55.1±14.9 years; type C 52.7±16.9 years). Normalized for gender disproportion, there was no significant gender predominance for any type (type A female:male = 1.4:1; type B female:male = 1.1:1; type C female:male=0.7:1). No statistical significance was found when evaluating for age or gender and prevalence of type although types A and B were found to be slightly more common in female patients.
Discussion Patients and methods The lateral projection of the cavernous segment of the right internal carotid artery was evaluated in 40 consecutive adult patients (54.2±15.0 years; female:male 2.1:1) undergoing cerebral angiography for evaluation of headache. A correlation was then made using the classification described by Lang and Reiter [7] (Fig. 1). No patient was found to have intracranial pathology such as tumor, aneurysm, signs of trauma, or hydrocephalus. Statistica for Windows was used for statistical analysis with significance set at p
ORIGINAL PAPER
Analysis of the tortuosity of the internal carotid artery in the cavernous sinus Christoph J. Griessenauer & Bulent Yalcin & Petru Matusz & Marios Loukas & Charles G. Kulwin & R. Shane Tubbs & Aaron A. Cohen Gadol
Received: 21 February 2015 / Accepted: 25 February 2015 # Springer-Verlag Berlin Heidelberg 2015
Abstract Background The morphology of the internal carotid artery at the skull base is important in radiologic interpretation, surgery, and more recently, endovascular interventional and diagnostic procedures. Therefore, a thorough knowledge of the shape of the carotid siphon can be important in the clinical realm. Methods In this study, we evaluated the shape of the carotid siphon from a lateral perspective on cerebral angiography. These shapes were then correlated to the Lang and Reiter classification. Results Types A, B, and C were distributed as follows: type A 12 (30 %), B 16 (40 %), 12 (30 %). There was no significant difference (p>0.05) in patient ages between the three types (type A 54.6±14.2 years, type B 55.1±14.9 years, and type C 52.7±16.9 years). Normalized for gender disproportion, there was no significant gender predominance for any type (type A female:male=1.4:1; type B female:male=1.1:1; type C female:male=0.7:1). C. J. Griessenauer : R. S. Tubbs (*) Pediatric Neurosurgery, Children’s of Alabama, Birmingham, AL, USA e-mail: [email protected] B. Yalcin Department of Anatomy, Gulhane Military Medical Academy, Ankara, Turkey P. Matusz Department of Anatomy, BVictor Babes^ University of Medicine and Pharmacy, Timisoara, Romania M. Loukas Department of Anatomical Sciences, St. George’s University, St. George, Grenada C. G. Kulwin : A. A. C. Gadol Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
Conclusions Such a classification scheme with additional application in another group might be of use to future studies aimed at the morphology of the cavernous part of the internal carotid artery. Keywords Anatomy . Skull base . Internal carotid . Artery . Surgery . Radiology
Introduction The cavernous sinuses are located on each side of the body of the sphenoid and have spatial relationships with the internal carotid artery (ICA), cranial nerves III, IV, V1, V2, VI, and the pituitary gland [1]. Therefore, this region is an area of interest to endocrinologists, neurologists, neurosurgeons, ophthalmologists, and otolaryngologists alike. The sinuses anastomose with each other through the intercavernous sinuses and the paired ICAs also contain extensive anastomoses [2]. The intracavernous portion of the internal carotid artery (cICA) is often referred to as the carotid siphon due to its double-bend morphology. The cICA extends from the superior border of the petrolingual ligament to the proximal dural ring and contains along its course from proximal to distal a posterior vertical segment, posterior bend, horizontal segment, anterior bend, and finally, an anterior vertical segment as it leaves the cavernous sinus and enters the subarachnoid space medial to the anterior clinoid process [3, 4]. Ziyal et al. [5] in 2005 further classified this segment of the ICA as being intradural and intracavernous. Although on average less than 2 cm long, the morphology of the cICA is very complex. This segment of the artery contains extensive fine branching with the two most common branches being the meningohypophyseal
Childs Nerv Syst
trunk (MHT) and the inferolateral trunk (ILT), also called artery of the inferior cavernous sinus. These typically branch off from the middle of the convex outer margin of the posterior bend and the central third of the inferolateral surface of the horizontal segment respectively [6]. In addition to variants of the branching pattern, the cICA may be curved at different angles along the two bends described earlier and coiled along its course. In this paper, we will refer to the combination of bending and coiling as the tortuosity of the vessel, investigate various attempts to classify tortuosity of the cICA, and focus on the clinical relevance of such classification.
Results Types A, B, and C were distributed as follows: type A 12 (30 %), B 16 (40 %), 12 (30 %) (Fig. 2). There was no significant difference (p>0.05) in patient ages between the 3 types (type A 54.6±14.2 years; type B 55.1±14.9 years; type C 52.7±16.9 years). Normalized for gender disproportion, there was no significant gender predominance for any type (type A female:male = 1.4:1; type B female:male = 1.1:1; type C female:male=0.7:1). No statistical significance was found when evaluating for age or gender and prevalence of type although types A and B were found to be slightly more common in female patients.
Discussion Patients and methods The lateral projection of the cavernous segment of the right internal carotid artery was evaluated in 40 consecutive adult patients (54.2±15.0 years; female:male 2.1:1) undergoing cerebral angiography for evaluation of headache. A correlation was then made using the classification described by Lang and Reiter [7] (Fig. 1). No patient was found to have intracranial pathology such as tumor, aneurysm, signs of trauma, or hydrocephalus. Statistica for Windows was used for statistical analysis with significance set at p
