Caroticoclinoid Bar: A Systematic Review and Meta-Analysis of Its Prevalence and Potential Implications in Cerebrovascular and Skull Base Surgery

Skandalakis, Georgios P.; Koutsarnakis, Christos; Pantazis, Nikos; Kalyvas, Aristotelis; Komaitis, Spyridon; Lani, Evgenia; Drosos, Evangelos; Κalamatianos, Theodosis; Hadjipanayis, Constantinos; Natsis, Konstantinos; Stranjalis, George; Piagkou, Maria

doi:10.1016/j.wneu.2019.01.017

Cited by 9 publications

(23 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…36 Obviously, the rule of thumb is to prevent these injuries by proper training and operator experience, using the "2 surgeons, 4 hands" method, and having a good grasp of patientspecific anatomy utilizing the best preoperative imaging techniques. 30,[37][38][39][40][41][42][43] Anatomical considerations in EES must be kept in the mind to avoid this serious complication. [44][45][46] However, ICA injury may still occur in the best of hands, 47 and apart from exsanguination, this injury may lead to a diverse range of vascular findings such as pseudoaneurysms, arterial spasm, arterial thrombosis/emboli, and caroticocavernous fistula formation.…”

Section: Discussionmentioning

confidence: 99%

Carotid Artery-Cavernous Segment Injury during an Endoscopic Endonasal Surgery: A Case Report and Literature Review of the Overlooked Option for Surgical Trapping in the Hyperacute Phase

et al. 2021

View full text Add to dashboard Cite

Internal carotid artery (ICA) injury is a catastrophic complication of endoscopic endonasal surgery (EES). However, its standard management, emergent endovascular treatment, may not always be available, and the transnasal approach may be insufficient to achieve hemostasis.A 44-year-old woman with pituitary adenoma underwent EES complicated with the ICA cavernous segment injury (CSI). In urgent intraoperative angiogram, a good collateral flow from the contralateral carotid circulation was observed. Due to the unavailability of intraoperative embolization, emergent surgical trapping was performed by combined transcranial and cervical approach. The patient recovered but later developed a giant cavernous pseudoaneurysm. During the pseudoaneurysm embolization, ICA was directly accessed via a 1.7-F puncture hole using a bare microcatheter technique. Then, both the aneurysm and parent artery were obliterated with coils. At the 4-year follow-up, the patient was asymptomatic without a residual tumor. To our knowledge, this is the first case of ICA–CSI during EES successfully treated with ICA trapping as a lifesaving urgent surgery that achieved a complete recovery after a pseudoaneurysm embolization. Although several studies reported that EES-related ICA–CSIs with percutaneous carotid artery access, neither our surgical salvage technique nor our carotid access and tract embolization techniques were previously described.

show abstract

Section: Discussionmentioning

confidence: 99%

Carotid Artery-Cavernous Segment Injury during an Endoscopic Endonasal Surgery: A Case Report and Literature Review of the Overlooked Option for Surgical Trapping in the Hyperacute Phase

et al. 2021

View full text Add to dashboard Cite

show abstract

“…The development of the sphenoid bone occurs from the endochondral ossification of the sphenoid body during the first trimester, a process regulated by matrix Gla proteins and osteopontin. The physiological understanding of this mechanism has still not been elucidated, in view of the complexity and high variability of the genetic control of these ossification centers (Skandalakis et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

“…The CF varies in incidence and morphology and constitutes the anterior part of the cavernous sinus roof. The first mention in the literature about the CF was published in 1855 by Friedrich Gustav Jakob Henle, a German pathologist and anatomist, and it is generally categorized as "complete" or "incomplete" (Henle, 1855;Skandalakis et al).…”

Section: Discussionmentioning

confidence: 99%

“…The conventional and two-dimensional CT scans may not detect the presence of CF, so coronal and three-dimensional thinsection reconstructions are necessary, especially on axial sections at the level of the upper parasellar region. Thus, the surgeon should be attentive even if the canal is not detected in these exams and, if it is identified, should prioritize the anterior intradural compared to extradural clinoidectomy, because it offers better visualization and lesser risk of injury to the ICA (Skandalakis et al;Jean, 2019). Besides surgical obstacles, the presence of the canal can compress or tension the ICA, with possible alteration in cerebral blood circulation (Singh).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Morphometric Analyses of the Caroticoclinoid and Interclinoid Foramina: A Study in Brazilian Dry Skulls

et al. 2021

View full text Add to dashboard Cite

The caroticoclinoid (CF) and the interclinoid (IF) foramina are variant formations of the middle cranial fossa, which result from idiopathic and possibly atavistic ossifications of the caroticoclinoid and interclinoid ligaments, respectively. Topographically, these foramina are intimately associated, to varying degrees, depending on their conformations, with the neurovascular elements of the paraclinoid region and have important clinical and surgical significance. Thus, this study, conducted from 38 dry skulls belonging to the shared collection of the Federal University of Juiz de Fora, Governador Valadares campus, revealed 11 skulls (28.95 %) with one of the two complete formations -the caroticoclinoid or the interclinoid, and in 6 skulls the caroticoclinoid foramen occurred uni or bilaterally. As a result, 50 % of these skulls presented the CF exclusively on the right (or 62.5 % of the total number of variant foramina), with an average transverse diameter of 4.91 mm and 5.8 mm AP (anteroposterior) diameter and an average area of 22.5 mm 2 . Concerning the IF, the findings occurred in 5 skulls with variable distributions between the clinoid processes and lateralities. The average length of the bone bridges in the IF was 7.7 mm. In conclusion, detailed anatomical knowledge of the caroticoclinoid and the interclinoid foramina is fundamental to the practice of neurosurgical procedures, since they have intimate relationships at a location of high structural complexity.

show abstract

“…[30, 66,88] (4) Drilling of the anterior clinoid, specifically in the presence of a carotico-clinoid bar, is another known risk factor. [31, 71,74] The prevalence of iatrogenic internal carotid injury in open skull base surgery is uncertain.…”

Section: Introductionmentioning

confidence: 99%

The surgical management of intraoperative intracranial internal carotid artery injury in open skull base surgery—a systematic review

et al. 2021

View full text Add to dashboard Cite

Intraoperative internal carotid artery (ICA) injury during open skull base surgery is a catastrophic complication. Multiple techniques and management strategies have been reported for endoscopic skull base surgery; however, the literature on managing this complication in open skull base surgery is limited. To perform a systematic review and give an overview of the different techniques described to manage this complication intraoperatively, a systematic review was conducted in PubMed, Ovid Medline, Ovid Embase and Scopus for literature published until July 2021. Titles and abstracts were screened. Studies meeting prespecified inclusion criteria were reviewed in full. PRISMA guidelines were strictly adhered to. Out of 4492 articles, only 12 articles could be included, reflecting an underreporting of open skull base ICA injuries. Multiple techniques can be used depending on the location and size of the injury as well as the surgeon's experience. Described techniques include the following: a primary repair via a micro-suture or nonpenetrating clips; wrapping or plugging; coating; occlusion of the parent artery with or without a bypass; packing with further endovascular management. A treatment algorithm is proposed.

show abstract

Caroticoclinoid Bar: A Systematic Review and Meta-Analysis of Its Prevalence and Potential Implications in Cerebrovascular and Skull Base Surgery

Cited by 9 publications

References 42 publications

Carotid Artery-Cavernous Segment Injury during an Endoscopic Endonasal Surgery: A Case Report and Literature Review of the Overlooked Option for Surgical Trapping in the Hyperacute Phase

Carotid Artery-Cavernous Segment Injury during an Endoscopic Endonasal Surgery: A Case Report and Literature Review of the Overlooked Option for Surgical Trapping in the Hyperacute Phase

Morphometric Analyses of the Caroticoclinoid and Interclinoid Foramina: A Study in Brazilian Dry Skulls

The surgical management of intraoperative intracranial internal carotid artery injury in open skull base surgery—a systematic review

Contact Info

Product

Resources

About