title: Transposition of the paraclival carotid artery: a novel concept of self-retaining vascular retraction during endoscopic endonasal skull base surgery technical report.
abstract: Fixed retraction of the internal carotid artery (ICA) has previously been described for use during transcranial microscopic surgery. We report the novel use of a self-retaining microvascular retractor for static repositioning and protection of the ICA during expanded endonasal endoscopic approaches to the paramedian skull base.
  
  
  
  The transmaxillary, transpterygoid approach was performed in five cadaver heads (ten sides). The self-retaining microvascular retractor was used to laterally reposition the pterygopalatine fossa contents during exposure of the pterygoid base/plates and the paraclival ICA to expose the petrous apex. Maximum ICA retraction distance was measured in the x-axis for all ten sides.
  
  
  
  The average horizontal distance of ICA retraction measured at the mid-paraclival segment for all ten sides was 4.75 mm. In all cases, the carotid artery was repositioned without injury to the vessel or disruption of the surrounding neurovascular structures.
  
  
  
  Static repositioning of the ICA and other delicate neurovascular structures was effectively performed during endonasal, endoscopic cadaveric surgery of the skull base and has potential merits in live patients.
authors.affiliation: Department of Neurosurgery, University of Colorado, 12631 E. 17th Ave., C307, Aurora, CO, 80045, USA.
authors.forename: Jacob L
authors.initials: JL
authors.lastname: Freeman
authors.affiliation: Department of Neurosurgery, University of Colorado, 12631 E. 17th Ave., C307, Aurora, CO, 80045, USA.
authors.forename: Raghuram
authors.initials: R
authors.lastname: Sampath
authors.affiliation: Department of Neurosurgery, University of Colorado, 12631 E. 17th Ave., C307, Aurora, CO, 80045, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Casey
authors.affiliation: Department of Otolaryngology, University of Colorado, 12631 E. 17th Ave., C307, Aurora, CO, 80045, USA.
authors.forename: Steven Craig
authors.initials: SC
authors.lastname: Quattlebaum
authors.affiliation: Department of Otolaryngology, University of Colorado, 12631 E. 17th Ave., C307, Aurora, CO, 80045, USA.
authors.forename: Vijay R
authors.initials: VR
authors.lastname: Ramakrishnan
authors.affiliation: Department of Neurosurgery, University of Colorado, 12631 E. 17th Ave., C307, Aurora, CO, 80045, USA. samy.youssef@ucdenver.edu.|Department of Otolaryngology, University of Colorado, 12631 E. 17th Ave., C307, Aurora, CO, 80045, USA. samy.youssef@ucdenver.edu.
authors.forename: A Samy
authors.initials: AS
authors.lastname: Youssef
mesh_terms: D002102:Cadaver; D002339:Carotid Arteries / Q000601:surgery*; D006801:Humans; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D009666:Nose / Q000601:surgery; D019291:Skull Base / Q000601:surgery*
keywords: Endonasal; Endoscopic; Internal carotid artery; Microvascular retractor; Transposition