Dual Endoscopic Endonasal Transsphenoidal and Precaruncular Transorbital Approaches for Clipping of the Cavernous Carotid Artery: A Cadaveric Simulation

Jeremy Ciporen; Brandon Lucke-Wold; Aclan Dogan; Justin S. Cetas; William E. Cameron

doi:10.1055/s-0036-1584094

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2016; 77(06): 485-490
DOI: 10.1055/s-0036-1584094

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Dual Endoscopic Endonasal Transsphenoidal and Precaruncular Transorbital Approaches for Clipping of the Cavernous Carotid Artery: A Cadaveric Simulation

Jeremy Ciporen

¹Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, United States

,

Brandon Lucke-Wold

²Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, United States

,

Aclan Dogan

¹Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, United States

,

Justin S. Cetas

¹Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, United States

,

William E. Cameron

³Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon, United States

› Author Affiliations

Abstract

Background Endoscopic skull base approaches are being used to address complicated neurovascular pathology. These approaches are safest when proximal vascular control of the cavernous carotid artery (CavCA) can be obtained.

Methods We present a cadaver-based anatomic simulation study showing the feasibility of clip placement for the CavCA as it courses through the cavernous sinus. The arterial vessels were injected with red microfil (Flow Tech, Carver, Massachusetts) to enhance visibility. The endoscope was directed through a precaruncular transorbital approach and instrumentation was managed through an endonasal transsphenoidal approach.

Results The dual approach minimized the “coning down” and instrument “sword fighting” that occurs as the rod lens endoscope and instruments are used laterally and posterior toward the clivus and brainstem. The precaruncular transorbital approach improved visualization of the clip application and improved the functional working area. The transorbital port allowed better appreciation of the distal clip tines, and the laterally positioned cranial nerves.

Conclusions The advantages may be most realized in the setting of endoscopic endonasal resection of highly vascular lesions and/or bleeding from a ruptured aneurysm being clipped. Simulated training provides an excellent opportunity to enhance skill sets and increase familiarity with anatomical visualization before entering the operative arena.

Keywords

cavernous carotid artery - CavCA - aneurysm clipping - simulation training - endonasal transsphenoidal approach - precaruncular transorbital approach

Full Text

References

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