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J Neurol Surg B Skull Base
DOI: 10.1055/a-2565-8881
Original Article

Anatomical Insights of the Internal Carotid Artery Dural Rings: Endonasal and Transorbital Comparative Perspective

Roberto Manfrellotti
1   Faculty of Medicine and Surgery, University of Barcelona, Barcelona, Spain
,
Alejandra Mosteiro
2   Department of Neurological Surgery, Institut Clínic de Neurociències, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
,
Dario Gagliano
3   Department of Neurochirurgia, Università Degli Studi di Milano, Milano, Italy
,
Lorena Gómez López
2   Department of Neurological Surgery, Institut Clínic de Neurociències, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
,
Nikolay Lasunin
4   Burdenko Research Institute of Neurosurgery, Moscow, Russia
,
Doriam Perera Valdivia
5   Department of Neurosurgery, Hospital Militar Escuela Dr Alejandro Dávila Bolaños, Managua, Nicaragua
,
Carlo Giorgio Giussani
6   Department of Neurosurgery, IRCCS San Gerardo dei Tintori Foundation Hospital, Monza, Lombardy, Italy
,
Giorgio Giovanni Carrabba
6   Department of Neurosurgery, IRCCS San Gerardo dei Tintori Foundation Hospital, Monza, Lombardy, Italy
,
Ramon Torné
2   Department of Neurological Surgery, Institut Clínic de Neurociències, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
,
Alberto Prats-Galino
1   Faculty of Medicine and Surgery, University of Barcelona, Barcelona, Spain
,
Alberto Di Somma
2   Department of Neurological Surgery, Institut Clínic de Neurociències, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
,
Joaquim Enseñat
2   Department of Neurological Surgery, Institut Clínic de Neurociències, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
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Abstract

Background

The clinoidal segment of the internal carotid artery (ICA) is a complex transition zone between the intracavernous and intradural spaces. It is bordered by the distal dural ring (DDR), proximal dural ring (PDR), and anterior clinoid process (ACP). This study provides an endoscopic anatomical analysis of the clinoidal region using the endonasal endoscopic approach (EEA) and endoscopic transorbital approach (ETOA).

Methods

Ten cadaveric head specimens were dissected at the Laboratory of Surgical Neuroanatomy of the University of Barcelona.

Results

EEA exposes the medial clinoidal region, revealing the connection between the PDR and parasellar ligaments, although their individual components remain indistinct. ACP removal clarifies the relationship between DDR, the falciform ligament, and the diaphragma sellae. ETOA provides access to the outer clinoidal region, isolating PDR and DDR and detailing their continuity with adjacent ligaments.

Conclusion

EEA and ETOA offer comprehensive insights into the clinoidal region's anatomy.

Keywords

carotid region - distal dural ring - endoscopic endonasal approach - endoscopic transorbital approach - proximal dural ring


Publication History

Received: 17 February 2025

Accepted: 21 March 2025

Accepted Manuscript online:
25 March 2025

Article published online:
21 April 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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