title: Exposure of the distal cervical segment of the internal carotid artery using the trans-spinosum corridor: cadaveric study of surgical anatomy.
abstract: BACKGROUND
  Exposure of the most distal portion of the cervical segment of the internal carotid artery (ICA) is technically challenging. Previous descriptions of cranial base approaches to expose this segment noted facial nerve manipulation, resection of the glenoid fossa, and significant retraction or resection of the condyle. We propose a new approach using the frontotemporal orbitozygomatic approach to expose the distal portion of the cervical segment of the ICA via the trans-spinosum corridor.
  
  
  METHODS
  Six formalin-fixed injected heads were used for cadaveric dissection. Two blocs containing the carotid canal and surrounding region were used for histological examination.
  
  
  RESULTS
  The ICA lies immediately medial to the vaginal process. The carotid sheath attaches laterally to the vaginal process. With use of the trans-spinosum corridor, the surgeon's line of sight courses in front of the temporomandibular joint, through the foramen spinosum, spine of the sphenoid, and vaginal process. Removal of the vaginal process exposes the vertical portion of the petrous segment of the ICA. The loose connective tissue space between the adventitia and the carotid sheath is easily entered from above. Incision of the carotid sheath exposes the ICA without disruption of the temporomandibular joint.
  
  
  CONCLUSIONS
  Control of the cervical segment of the ICA can be critical when dealing with cranial base tumors that invade or surround the petrous segment of the ICA. This novel technique through the trans-spinosum corridor can effectively expose the distal portion of the cervical segment of the ICA without causing manipulation of the facial nerve and while maintaining the integrity of the temporomandibular joint.
authors.affiliation: Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
authors.forename: Sebastien C
authors.initials: SC
authors.lastname: Froelich
authors.forename: Khaled M
authors.initials: KM
authors.lastname: Abdel Aziz
authors.forename: Nicholas B
authors.initials: NB
authors.lastname: Levine
authors.forename: Myles L
authors.initials: ML
authors.lastname: Pensak
authors.forename: Philip V
authors.initials: PV
authors.lastname: Theodosopoulos
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Keller
mesh_terms: D002102:Cadaver; D002343:Carotid Artery, Internal / Q000033:anatomy & histology* / Q000601:surgery*; D002574:Cervical Vertebrae / Q000033:anatomy & histology* / Q000601:surgery*; D006801:Humans; D019635:Neurosurgical Procedures / Q000379:methods*; D014656:Vascular Surgical Procedures / Q000379:methods*