Preoperative assessment of the risk of cavernous ICA injury in endoscopic transsphenoidal surgery
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In endoscopic endonasal transsphenoidal procedures, ICA injury occurs in up to 3.8% . The highest hazard of injury is in case of contact between the ICA and pituitary gland, during opening of the dura. Preoperative imaging, i.e. CTA, MRA, supports objectively intraoperative techniques of imaging. CTA as well as MRA are essential to access anatomic details in variability of cavernous segments of the ICA (C4 ICA). The aim of the study was to measure the space between Internal Carotid Arteries and distances between the pituitary gland and ICA on both sides. Anatomic relations between left and right ICAs were accessed on CTA (coronal scans) at levels: A – The most concave point of the C4–C5 bend; B – The most convex point of the C4 bend; C – The C4 posterior ascending portion. Distances between pituitary gland and ICAs were measured on both sides on MRA (axial scans): A’ – The most concave point of C4–C5 bend; B’ – The most convex point of the C4 bend. The Statistica 13 (StatSoft) software was used for the statistical analysis. The Mann-Whitney U test was applied to determine differences between the groups. To analyze the strength of correlations between the quantitative variables, Spearman’s rank correlation coefficients were calculated. The results were considered statistically significant at the level of P < 0.05. Distance reduction was shown between pituitary glands and cavernous segment (C4) of ICAs on both sides, which is related to age. This has impact on surgical planning and highlights the risk of intraoperative injury of ICAs.
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