Surgical anatomy of the internal carotid plexus branches to the abducens nerve in the cavernous sinus

Iwanaga, Joe; Anand, Mahindra; Camacho, Amarilis; Rodríguez, Félix D.; Watson, Caroline; Caskey, Eric; Dumont, Aaron S.; Tubbs, R. Shane

doi:10.1016/j.clineuro.2020.105690

Cited by 9 publications

(9 citation statements)

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“…The AN relationship to the cavernous part of the ICA and ICP also has clinical implications. As Iwanaga et al [ 9 ] concluded, neurosurgeons who operate in and around the CS should be aware of such relations as unwanted tension on the cavernous part of the ICA or AN during dissection can result in Horner’s syndrome, miosis, increased accommodation, or ocular hypotony. AN palsy can also result from an aneurysm or arterial dissection of the cavernous part of the ICA as those conditions can cause direct compression to the nerve or interruption of its blood supply [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

“…The cavernous portion (C4 segment) of the internal carotid artery usually has an S-shaped course within the CS [ 7 ]. The ICA is accompanied by a network of sympathetic nerves known as the internal carotid plexus (ICP) [ 7 , 8 , 9 , 10 ]. The abducens nerve (AN) runs between the tortuous cavernous carotid siphon and the lateral wall of the CS; The oculomotor, trochlear, and ophthalmic nerves, in turn, run in the lateral wall of the CS without being in direct contact with the venous blood [ 5 , 6 , 11 , 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Gross and Micro-Anatomical Study of the Cavernous Segment of the Abducens Nerve and Its Relationships to Internal Carotid Plexus: Application to Skull Base Surgery

et al. 2021

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The present study aims to provide detailed observations on the cavernous segment of the abducens nerve (AN), emphasizing anatomical variations and the relationships between the nerve and the internal carotid plexus. A total of 60 sides underwent gross-anatomical study. Five specimens of the AN were stained using Sihler’s method. An additional five specimens were subjected to histological examination. Four types of AN course were observed: a single nerve along its entire course, duplication of the nerve, division into separate rootlets at the point of contact with the cavernous part of the internal carotid artery (ICA), and early-branching before entering the orbit. Due to the relationships between the ICA and internal carotid plexus, the cavernous segment of the AN can be subdivided into a carotid portion located at the point of contact with the posterior vertical segment of the cavernous ICA and a prefissural portion. The carotid portion of the cavernous AN segment is a place of angulation, where the nerve always directly adheres to the ICA. The prefissural portion of the AN, in turn, is the primary site of fiber exchange between the internal carotid plexus and either the AN or the lateral wall of the cavernous sinus.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Gross and Micro-Anatomical Study of the Cavernous Segment of the Abducens Nerve and Its Relationships to Internal Carotid Plexus: Application to Skull Base Surgery

et al. 2021

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“…10 In the cavernous segment, multiple smaller bundles form 10 before providing small branches to the abducens nerve and the ophthalmic nerve. 11,12 CSP schwannomas have been rarely described, with eight cases reported in the literature (Table 1). The tumor location dictates the clinical presentation, and distinct entities have been described.…”

Section: Anatomical Considerationsmentioning

confidence: 99%

Neurofibroma of the internal carotid artery cavernous sympathetic plexus: illustrative case

Trimble¹,

Dawes²,

Zeineddine³

et al. 2023

Journal of Neurosurgery: Case Lessons

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BACKGROUND Intracranial carotid sympathetic plexus (CSP) nerve sheath tumors have rarely been reported in the literature. This study describes the first reported case of a CSP neurofibroma and the first case of a CSP nerve sheath tumor treated via an endoscopic endonasal approach followed by adjuvant radiosurgery. OBSERVATIONS A 53-year-old man presented with 3 days of headaches and diplopia and was found to have a complete left abducens nerve palsy. Computed tomography (CT) revealed a smoothly dilated left carotid canal, CT angiography revealed a superiorly displaced left internal carotid artery (ICA), and magnetic resonance imaging revealed a T2-hyperintense and avidly enhancing lesion in the left cavernous sinus encasing the ICA. The patient underwent subtotal resection via an endoscopic transsphenoidal transcavernous approach followed by Gamma Knife radiosurgery. LESSONS Nerve sheath tumors arising from the CSP are extremely rare but need to be considered when assessing unusual cavernous sinus lesions. The clinical presentation is dependent on the anatomical location of the tumor and its relationship to the ICA. The optimal treatment paradigm is unknown.

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“…Despite results published from specialised centres [ 5 , 6 , 7 , 8 ], surgery within the cavernous sinus often increases neurological deficits and carries a risk of death [ 8 , 9 , 10 , 11 , 12 , 13 ]. This is due to the complex anatomy of CSMs, including a segment of the internal carotid artery (ICA); the sympathetic plexus and cranial nerves (CN) III, IV, Va, Vb and VI; and the high blood flow within the venous plexus [ 14 , 15 , 16 , 17 ]. For small- and medium-sized CSMs, stereotactic radiosurgery (SRS) is an alternative that provides high local tumour control and significant improvement in CN deficits [ 1 , 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Stereotactic Radiosurgery for Benign Cavernous Sinus Meningiomas: A Multicentre Study and Review of the Literature

Santacroce

Tuleasca

Motti

et al. 2022

Cancers

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Cavernous sinus meningiomas (CSMs) remain a surgical challenge due to the intimate involvement of their contained nerves and blood vessels. Stereotactic radiosurgery (SRS) is a safe and effective minimally invasive alternative for the treatment of small- to medium-sized CSMs. Objective: To assess the medium- to long-term outcomes of SRS for CSMs with respect to tumour growth, prevention of further neurological deterioration and improvement of existing neurological deficits. This multicentric study included data from 15 European institutions. We performed a retrospective observational analysis of 1222 consecutive patients harbouring 1272 benign CSMs. All were treated with Gamma Knife stereotactic radiosurgery (SRS). Clinical and imaging data were retrieved from each centre and entered into a common database. All tumours with imaging follow-up of less than 24 months were excluded. Detailed results from 945 meningiomas (86%) were then analysed. Clinical neurological outcomes were available for 1042 patients (85%). Median imaging follow-up was 67 months (mean 73.4, range 24–233). Median tumour volume was 6.2 cc (+/−7), and the median marginal dose was 14 Gy (+/−3). The post-treatment tumour volume decreased in 549 (58.1%), remained stable in 336 (35.6%) and increased in only 60 lesions (6.3%), yielding a local tumour control rate of 93.7%. Only 27 (2.8%) of the 60 enlarging tumours required further treatment. Five- and ten-year actuarial progression-free survival (PFS) rates were 96.7% and 90.1%, respectively. Tumour control rates were higher for women than men (p = 0.0031), and also for solitary sporadic meningiomas (p = 0.0201). There was no statistically significant difference in outcome for imaging-defined meningiomas when compared with histologically proven WHO Grade-I meningiomas (p = 0.1212). Median clinical follow up was 61 months (mean 64, range 6–233). Permanent morbidity occurred in 5.9% of cases at last follow-up. Stereotactic radiosurgery is a safe and effective method for treating benign CSM in the medium term to long term.

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Surgical anatomy of the internal carotid plexus branches to the abducens nerve in the cavernous sinus

Cited by 9 publications

References 9 publications

Gross and Micro-Anatomical Study of the Cavernous Segment of the Abducens Nerve and Its Relationships to Internal Carotid Plexus: Application to Skull Base Surgery

Gross and Micro-Anatomical Study of the Cavernous Segment of the Abducens Nerve and Its Relationships to Internal Carotid Plexus: Application to Skull Base Surgery

Neurofibroma of the internal carotid artery cavernous sympathetic plexus: illustrative case

Stereotactic Radiosurgery for Benign Cavernous Sinus Meningiomas: A Multicentre Study and Review of the Literature

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