title: Intrapetrous Internal Carotid Artery: Evaluation of Exposure, Mobilization and Surgical Maneuvers Feasibility from a Retrosigmoid Approach in a Cadaveric Model.
abstract: OBJECTIVE
  To provide a quantification of the exposure of the vertical and horizontal segments of the intrapetrous carotid artery (IPCA) and to evaluate the possibilities of its mobilization and of performing surgical maneuvers on it using the retrosigmoid approach.
  
  
  METHODS
  Twelve surgical dissections were performed bilaterally on 6 fresh cadavers. Predissection computed tomography (CT) scans with bone fiducials for intraoperative navigation were acquired. A retrosigmoid craniectomy was performed. The inframeatal space was drilled, the horizontal (HoIPCA) and vertical (VeIPCA) segments of the IPCA were exposed, and their measurements were recorded. The carotid canal was enlarged, the artery was carefully detached from the bone, and a vessel loop was inserted in order to mobilize its horizontal segment. Afterwards we performed different surgical maneuvers: We inflated a 5-French Fogarty balloon to compress the IPCA and repaired a 7-mm arteriotomy with a running suture. Specimens underwent a new CT scan to evaluate the amount of bone removal and the integrity of the inner ear structures.
  
  
  RESULTS
  The HoIPCA and VeIPCA were exposed and anatomically preserved in all specimens without injuring the surrounding neurovascular structures. The HoIPCA presented an average length of 24.89 mm (range: 19.41-31.47 mm), and the VeIPCA presented an average length of 10.07 mm (range: 8.92-11.58 mm). The possibility of IPCA mobilization and the feasibility of performing surgical maneuvers were demonstrated. Postdissection CT scan showed the preservation of inner ear structures.
  
  
  CONCLUSIONS
  Exposure and mobilization of the IPCA using a retrosigmoid approach are feasible and could represent a viable option for the possibility of reaching a total resection of selected skull base tumors, even when involvement of the carotid canal is present.
authors.affiliation: Institute of Neurosurgery, Catholic University of Rome, Rome, Italy; Dardinger Microneurosurgical Skull Base Laboratory, Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA.
authors.forename: Alba
authors.initials: A
authors.lastname: Scerrati
authors.affiliation: Dardinger Microneurosurgical Skull Base Laboratory, Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA.
authors.forename: Serdar
authors.initials: S
authors.lastname: Ercan
authors.affiliation: Dardinger Microneurosurgical Skull Base Laboratory, Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA; Department of Neurosurgery, the First Affiliated Hospital, China Medical University Heping District, Shenyang City, Liaoning Province, China.
authors.forename: Pengfei
authors.initials: P
authors.lastname: Wu
authors.affiliation: Department of Radiology and Wright Center of Innovation in Biomedical Imaging, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA.
authors.forename: Jun
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Radiology and Wright Center of Innovation in Biomedical Imaging, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA. Electronic address: mario.ammirati@osumc.edu.
authors.forename: Mario
authors.initials: M
authors.lastname: Ammirati
mesh_terms: D021721:Balloon Occlusion / Q000379:methods; D002102:Cadaver; D002343:Carotid Artery, Internal / Q000601:surgery*; D003392:Cranial Sinuses / Q000601:surgery; D003399:Craniotomy / Q000379:methods; D004210:Dissection / Q000379:methods; D005240:Feasibility Studies; D006801:Humans; D038361:Neuronavigation / Q000379:methods; D059351:Organ Sparing Treatments / Q000379:methods; D010579:Petrous Bone / Q000098:blood supply; D013536:Suture Techniques; D014057:Tomography, X-Ray Computed
keywords: Carotid artery mobilization; Inframeatal drilling; Intrapetrous internal carotid artery; Jugular foramen; Paragangliomas; Schwannomas