TY - JOUR
T1 - Relationships of the vidian nerve and internal carotid artery
T2 - MRI and intraoperative surgical evaluation
AU - Dallan, Iacopo
AU - Verstegen, Marco
AU - Canovetti, Silvia
AU - Turri-Zanoni, Mario
AU - Georgalas, Christos
AU - Fiacchini, Giacomo
AU - Cambi, Christina
AU - Prevedello, Daniel
AU - van Furth, Wouter
N1 - Publisher Copyright:
© Società Italiana di Otorinolaringoiatria e Chirurgia Cervico-Facciale.
PY - 2024/8
Y1 - 2024/8
N2 - Objective. Skull base anatomy around the internal carotid artery (ICA) is extremely complex. Among anatomical landmarks studied, the vidian canal has been thoroughly evaluated, unlike the vidian nerve (VN). Our aim is to evaluate the VN-ICA relationships, and understand their role in terms of surgical planning. Methods. Fifty MRI examinations of 100 healthy petro-spheno-clival regions were reviewed in order to evaluate the relationship between the vidian nerve axis (VNA) and the petrous ICA. Twentyseven cases of expanded endonasal approaches to petrous apex region were evaluated to check the VN-ICA relationship intraoperatively. Results. MRI evaluations showed that, in 23% of cases, the VNA was below the edge of the ICA, in 45% it was at the edge of the ICA and in 32% it ended up above the edge of the ICA. Surgically speaking, in 9 of 28 petrous apex approaches, the VN ended above the inferior edge of the petrous carotid. Conclusions. MRI evaluation adds useful information in planning the surgical approach to petro-spheno-clival regions, even if the identification of VNA, in these cases, may not be radiologically possible. Surgical experience confirms the importance of VN identification in guiding the surgeon in complex cases, and also outline the possible risks of relying only on this landmark.
AB - Objective. Skull base anatomy around the internal carotid artery (ICA) is extremely complex. Among anatomical landmarks studied, the vidian canal has been thoroughly evaluated, unlike the vidian nerve (VN). Our aim is to evaluate the VN-ICA relationships, and understand their role in terms of surgical planning. Methods. Fifty MRI examinations of 100 healthy petro-spheno-clival regions were reviewed in order to evaluate the relationship between the vidian nerve axis (VNA) and the petrous ICA. Twentyseven cases of expanded endonasal approaches to petrous apex region were evaluated to check the VN-ICA relationship intraoperatively. Results. MRI evaluations showed that, in 23% of cases, the VNA was below the edge of the ICA, in 45% it was at the edge of the ICA and in 32% it ended up above the edge of the ICA. Surgically speaking, in 9 of 28 petrous apex approaches, the VN ended above the inferior edge of the petrous carotid. Conclusions. MRI evaluation adds useful information in planning the surgical approach to petro-spheno-clival regions, even if the identification of VNA, in these cases, may not be radiologically possible. Surgical experience confirms the importance of VN identification in guiding the surgeon in complex cases, and also outline the possible risks of relying only on this landmark.
KW - endoscopic skull base surgery
KW - petrous internal carotid artery
KW - surgical anatomy
KW - vidian canal
KW - vidian nerve
UR - https://www.scopus.com/pages/publications/85205335704
U2 - 10.14639/0392-100X-N2889
DO - 10.14639/0392-100X-N2889
M3 - Article
C2 - 39347552
AN - SCOPUS:85205335704
SN - 0392-100X
VL - 44
SP - 269
EP - 274
JO - Acta Otorhinolaryngologica Italica
JF - Acta Otorhinolaryngologica Italica
IS - 4
ER -