title: Indicators of a Reduced Intercarotid Artery Distance in Patients Undergoing Endoscopic Transsphenoidal Surgery.
abstract: Objective To identify clinicopathologic factors associated with a reduced intercarotid distance (ICD) and subgroups at risk for internal carotid artery injury during transsphenoidal surgery. Design A retrospective case-control study. Setting This study was conducted at the McGill University Health Centre, a university-affiliated tertiary care center. Participants Patients with a sellar or parasellar tumor and nontumor controls were included in the study. Main Outcome Measures The smallest distance between the internal carotid arteries at the clival, cavernous, and paraclinoid segments on coronal magnetic resonance imaging was measured. Demographic profiles, cephalometric measurements, tumor dimensions, and sphenoid configuration were assessed as potential determinants of the ICD. Results A total of 212 cases and 34 controls were analyzed. Widening of the ICD at the three segments of the internal carotid arteries was found in patients with pituitary macroadenomas (p < 0.01). Patients with a growth hormone-secreting adenoma had a markedly reduced ICD at the clivus compared with controls (1.59 cm versus 1.77 cm; p = 0.02; 95% confidence interval [CI], 0.03-0.32). The paraclinoid ICD was reduced in patients with an anterior fossa meningioma (1.24 cm versus 1.33 cm; p = 0.04; 95% CI, 0.01-0.45). Conclusion Identifying clinicopathologic factors affecting the ICD can help surgeons recognize constraints to endoscopic access of the skull base and avoid inadvertent arterial injury.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, McGill University, Royal Victoria Hospital, Montreal, Quebec, Canada.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Mascarella
authors.affiliation: Department of Diagnostic Radiology, McGill University, Jewish General Hospital, Montreal, Quebec, Canada.
authors.forename: Reza
authors.initials: R
authors.lastname: Forghani
authors.affiliation: Department of Neurosurgery, Jewish General Hospital, Montreal, Quebec, Canada.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Di Maio
authors.affiliation: Department of Neurosurgery, Montreal Neurological Hospital, Montreal, Quebec, Canada.
authors.forename: Denis
authors.initials: D
authors.lastname: Sirhan
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, McGill University, Royal Victoria Hospital, Montreal, Quebec, Canada.
authors.forename: Anthony
authors.initials: A
authors.lastname: Zeitouni
authors.affiliation: Department of Neurosurgery, Jewish General Hospital, Montreal, Quebec, Canada.
authors.forename: Gerard
authors.initials: G
authors.lastname: Mohr
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, McGill University, Royal Victoria Hospital, Montreal, Quebec, Canada.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Tewfik
keywords: intercarotid distance; meningioma; pituitary adenoma; skull base surgery