title: Endoscopic endonasal control of the paraclival internal carotid artery by Fogarty balloon catheter inflation: an anatomical study.
abstract: OBJECTIVE Neurosurgical management of many vascular and neoplastic lesions necessitates control of the internal carotid artery (ICA). The aim of this study was to investigate the feasibility of achieving control of the ICA through the endoscopic endonasal approach by temporary occlusion with a Fogarty balloon catheter. METHODS Ten endoscopic endonasal paraseptal approaches were performed on cadaveric specimens. A Fogarty balloon catheter was inserted through a sellar bony opening and pushed laterally and posteriorly extraarterially along the paraclival carotid artery. The balloon was then inflated, thus achieving temporary occlusion of the vessel. The position of the catheter was confirmed with CT scans, and occlusion of the ICA was demonstrated with angiography. The technique was performed in 2 surgical cases of pituitary macroadenoma with cavernous sinus invasion. RESULTS Positioning the Fogarty balloon catheter at the level of the paraclival ICA was achieved in all cadaveric dissections and surgical cases through a minimally invasive, quick, and safe approach. Inflation of the Fogarty balloon caused interruption of blood flow in 100% of cases. CONCLUSIONS Temporary occlusion of the paraclival ICA performed through the endoscopic endonasal route with the aid of a Fogarty balloon catheter may be another maneuver for dealing with intraoperative ICA control. Further clinical studies are required to prove the efficacy of this method.
authors.affiliation: Department of Neuroscience, Neurosurgery, University of Rome "Sapienza," Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ruggeri
authors.affiliation: Department of Neurosurgery, Hospital Clinic, Faculty of Medicine, Universitat de Barcelona, Spain.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Enseñat
authors.affiliation: Laboratory of Surgical NeuroAnatomy (LSNA), Human Anatomy and Embryology Unit, Faculty of Medicine, Universitat de Barcelona, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Prats-Galino
authors.affiliation: Department of Radiology, Hospital Clinic, Faculty of Medicine, Universitat de Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Lopez-Rueda
authors.affiliation: Department of Radiology, Hospital Clinic, Faculty of Medicine, Universitat de Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Berenguer
authors.affiliation: Department of Neuroscience, Neurosurgery, University of Rome "Sapienza," Rome, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Cappelletti
authors.affiliation: Neurosurgical Department, "G. Rummo" Hospital of Benevento, Benevento, Italy; and.
authors.forename: Matteo
authors.initials: M
authors.lastname: De Notaris
authors.affiliation: Laboratory of Surgical NeuroAnatomy (LSNA), Human Anatomy and Embryology Unit, Faculty of Medicine, Universitat de Barcelona, Spain.|Department of Neuroscience, Neurosurgery, University of Padua, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: d'Avella
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D063125:Balloon Embolectomy / Q000379:methods*; D002343:Carotid Artery, Internal / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002426:Cavernous Sinus; D002533:Cerebral Angiography; D005240:Feasibility Studies; D006801:Humans; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D044583:Neuroendoscopy / Q000379:methods*; D010911:Pituitary Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed
keywords: Fogarty balloon catheter; ICA; ICA = internal carotid artery; endoscopic endonasal; paraclival; proximal control; skull base