title: Trans-sphenoidal Approach to the Supraclinoid Internal Carotid Artery for Endovascular Access in a Cadaver.
abstract: OBJECTIVE
  Sometimes, intracranial pathology in the distal vasculature cannot be accessed by standard endovascular techniques because of occlusion or insurmountable tortuosity of theinternal carotid artery (ICA). A trans-sphenoidal surgical approach can follow a similar trajectory to the course of the supraclinoid ICA. This study evaluates the feasibility of a trans-sphenoidal approach to the supraclinoid ICA for endovascular access.
  
  
  METHODS
  In a fresh cadaver head, the sphenoid sinus was dissected through a trans-sphenoidal route. Bone over the carotid prominence was removed to expose the ICA. The artery was catheterized using the Seldinger technique, and three-dimensional digital subtraction angiography was performed to evaluate the procedure.
  
  
  RESULTS
  The catheter was successfully inserted into the supraclinoid ICA via the trans-sphenoidal route. Three-dimensional radiographic reconstruction confirmed placement of the catheter and the trajectory of the sheath into the supraclinoid ICA.
  
  
  CONCLUSIONS
  While the trans-sphenoidal route has innumerable disadvantages over the standard endovascular access techniques, this route could be considered when other treatment options are too risky or impractical.
authors.affiliation: Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Andrew Kelly
authors.initials: AK
authors.lastname: Johnson
authors.forename: Hunter Kegan
authors.initials: HK
authors.lastname: Holt
authors.forename: Anthony Joseph
authors.initials: AJ
authors.lastname: Serici
authors.forename: Roham
authors.initials: R
authors.lastname: Moftakhar
keywords: Endovascular; Internal carotid artery; Trans-sphenoid