High bifurcation of common carotid artery, anomalous origin of ascending pharyngeal artery and anomalous branching pattern of external carotid artery

We present a rare case of combined high bifurcation of the common carotid artery, anomalous origin of the ascending pharyngeal artery and unusual branching pattern of the external carotid artery. The right common carotid artery bifurcated at the level between the second and the third cervical vertebrae, giving rise to the ascending pharyngeal artery just below the bifurcation. The right external carotid artery branched directly at its origin into the superior thyroid, lingual and occipital arteries and the distal part of the external carotid artery. The latter gave rise to the right facial artery and finally bifurcated into the maxillary and superficial temporal arteries. The right posterior auricular artery arose from the right occipital artery. The finding was unilateral and other vascular anomalies were not observed. The embryogenesis of such a combination of anomalies is not clear, but the anatomic consequences may have important clinical implications.     

Embryology of the internal carotid artery dural crossing: apropos of a continuous series of 48 specimens

The aim of this study was to describe the embryologic and foetal development of the anterior paraclinoid region and more precisely the relationship of the internal carotid artery to the dura mater. This has been done by examining a collection of histological sections, representing a continuous series of 48 embryologic and foetal specimens, covering the period of the first 6 months of intra-uterine life. Neurological and vascular elements develop during the embryologic period; the internal carotid artery is recognizable in the various sections of its course and acquires a histological adult parietal constitution. The foetal period corresponds to the development of the meningeal structures. The superior, medial and lateral walls appear on the fifteenth week of amenorrhoea and do not change after that. The internal carotid artery enters subarachnoid space accompanied by a sleeve of mesenchymatous cells, which fixes it to the anterior clinoid process. The constitution of this sleeve, arising from the superior wall of the lateral sellar compartment, remained independent of the principle vascular part, which allows the formation of a plan of cleavage. The foetal relations of the dura mater and the internal carotid artery were seen to be different from those of adult subjects described in the literature, suggesting an existence of period of maturation postnatally.     

Association between internal carotid artery morphometry and posterior communicating artery aneurysm

PURPOSE: The goal of this study was to directly measure the association between the internal carotid artery (ICA) morphometry and the presence of ICA-posterior communicating artery (PCOM) aneurysm. MATERIALS AND METHODS: The authors intraoperatively measured the length of the supraclinoid ICA because it is impossible to radiologically determine the exact location of the anterior clinoid process. We used an image analyzer with a CT angiogram to measure the angle between the skull midline and the terminal segment of the ICA (ICA angle), as well as the diameter of the ICA. The lengths and diameters of the supraclinoid ICA and the ICA angle were compared among PCOM aneurysms, anterior communicating artery (ACOM) aneurysms, and middle cerebral artery (MCA) bifurcation aneurysms (n=27 each). Additionally, the lengths and the diameters of M1 and A1 were compared for each aneurysm. RESULTS: The lengths of the supraclinoid ICA were 11.9+/-2.3 mm. The lengths of the supraclinoid ICA in patients with ICA-PCOM aneurysms (9.7+/-2.8 mm) were shorter than those of patients with ACOM aneurysms (13.8+/-2.2 mm, Student's t-test, p<0.001) and with MCA bifurcation aneurysms (12.2+/-1.9 mm, Student's t-test, p<0.001). The diameters of the supraclinoid ICA and A1 in patients with ACOM aneurysms were larger than those in patients with MCA bifurcation aneurysms (Student's t-test, p<0.05). There were no significant differences in the lengths of M1 and A1, ICA angle, or diameter of M1 for each aneurysm. CONCLUSION: These results suggest that the relatively shorter length of the supraclinoid ICA may be a novel risk factor for the development of ICA-PCOM aneurysm with higher hemodynamic stress.     

垂体腺瘤对颈内动脉影响的MRI观测

目的：旨在探索颈内动脉与垂体腺瘤的关系。方法：通过对３０例垂体腺瘤患者ＭＲＩ的观测,测量颈内动脉在海绵窦段的间距。结果：间距２０．１ｍｍ,而且随垂体腺瘤左右径的增大,颈内动脉间距随之增大,肿瘤对颈内动脉向外侧推移、包裹、粘连可能性亦增加。结论：结果表明临床经鼻—蝶窦垂体腺瘤手术时,向两侧海绵窦方向探查和刮除腺瘤距中线平均不应超过１ｃｍ。     

喉罩对颈总动脉和颈内动脉血流动力学的影响

目的 研究喉罩对颈总动脉(CCA)和颈内动脉(ICA)内径、血流速率和血流量等血流动力学参数的影响.方法 随机选择择期全麻下行腹腔镜胆囊切除术患者60例,为美国麻醉医师协会(ASA)Ⅰ～Ⅲ级.根据不同年龄分为中青年组(A组,20～59岁)和老年组(B组,60～85岁).按不同的喉罩套囊内压力将A组和B组分为4个亚组,即A1、B1(套囊内压为20～30 cm H2O)(1 cm H2O=0.098 kPa)和A2、B2(套囊内压为40～50 cm H2O),每组15例.所有患者术毕后送入ICU复苏,尚未清醒时拔除气管导管,而后置入喉罩.记录置入喉罩前(T0),置入喉罩后3 min(T1)、10 min(T2)和拔除喉罩后(T3)各时点CCA和ICA的内径、血流速率和血流量等血流动力学参数以及生命体征参数.结果 CCA、ICA的内径和CCA血流量的基础值B组比A组要大(P<0.05).与T0比较,在T1和T2时点,A组和B组CCA内径分别减少9.5%～12.9%和14.5%～24.3%(P<0.05或P<0.01),其中以B2组减少最为显著,A2组和B2组ICA内径分别减少10.9%和16.3%(P<0.05).CCA和ICA的血流速率无明显变化(P>0.05).与T0比较,A组和B组,T1和T2时CCA的血流量分别减少9.3%～10.7%和12.2%～19.1%(P<0.05),其中以B2组减少最为显著,A组和B组ICA血流量分别减少10.0%～13.5%和13.9%～16.6%(P<0.05).在T3时点各观察指标均恢复至T0水平.结论 喉罩通气时,CCA和ICA的内径有所缩小,其血流量相应减少,老年患者减少更为明显,而其血流速率则无明显改变.     

Maxillary-to-petrous internal carotid artery bypass: an anatomical feasibility study

The possibility for maxillary artery (MA) to petrous internal carotid artery (ICA) bypass was investigated. Five adult cadavers were dissected bilaterally. After zygomatic arch osteotomy, the coronoid process was sectioned at its base. An extensive infratemporal craniotomy was performed at the level of foramina ovale, rotundum and spinosum. The petrous portion of the ICA was exposed by drilling away the floor of the middle fossa, posterior to the foramen ovale and medial to the foramen spinosum. The MA was identified medial to the infratemporal crest and was followed in the pterygopalatine fossa, then transected at the origin of the infraorbital artery. The MA graft was brought posteromedially to reach the petrous ICA. The mean caliber of the MA before the origin of the infraorbital artery was 2.54±0.31 mm, 2.76±0.14 mm at the site of anastomosis, and 3.46±0.32 mm after giving off the middle meningeal artery. The average length of the MA between the middle meningeal artery and the infraorbital artery was 43.4±2.35 mm, and up to the site of anastomosis was 37.64±1.68 mm. We conclude that the length and diameter of the MA are sufficient for a tension-free anastomosis between MA and petrous ICA, and such a procedure could be used in the treatment of patients with tumors of the infratemporal fossa invading the high cervical ICA.

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Electronic Supplementary Material The french version of this article is available in the form of electronic supplementary material and can be obtained by using the Springer Link server located at

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Étude anatomique des possibilités de by-pass entre la partie pétreuse de l'artère carotide interne et l'artère maxillaire

Résumé La possibilité d'un by-pass entre l'artère maxillaire et la partie pétreuse de l'artère carotide interne a été étudiée. Cinq cadavres adultes ont été disséqués des deux côtés. Après ostéotomie de l'arcade zygomatique, le processus coronoïde était sectionné à sa base. Une large craniotomie infra-temporale était effectuée au niveau du foramen ovale, du foramen rond et du foramen épineux. La partie pétreuse de l'artère carotide interne était exposée par fraisage du plancher de la fosse cérébrale moyenne, en arrière du foramen ovale et en dedans du foramen épineux. L'artère maxillaire était identifiée en dedans de la crête infra-temporale et suivie dans la fosse ptérygo-palatine, puis sectionnée à l'origine de l'artère infra-orbitaire. Le greffon d'artère maxillaire était transposé en dedans et en arrière pour atteindre la partie pétreuse de l'artère carotide interne. Le calibre moyen de l'artère maxillaire était de 2,54±0,31 mm à l'origine de l'artère infra-orbitaire, 2,76±0,14 mm au niveau de l'anastomose, et 3,46±0,32 mm après la naissance à l'artère méningée moyenne. La longueur moyenne de l'artère maxillaire entre l'artère méningée moyenne et l'artère infra-orbitaire était de 43,4±2,35 mm et au-delà du site d'anastomose était de 37,64±1,68 mm. Nous en avons conclu que la longueur et le diamètre de l'artère maxillaire était suffisant pour une anastomose sans tension entre l'artère maxillaire et la partie pétreuse de l'artère carotide interne. Ainsi, une telle technique pourrait être utilisée pour le traitement de patients porteurs d'une tumeur de la fosse infra-temporale envahissant la partie cervicale haute de l'artère carotide interne.

     

Anatomic evaluation of the carotid artery bifurcation in cadavers: implications for open and endovascular therapy

Knowledge of carotid bifurcation (CB), common carotid artery (CCA) and its branches and their recognition during diagnostic imaging are also important for vascular surgical procedures in the region, such as carotid endarterectomy or radical neck dissection, catheterization and aneurysms. The surgical anatomy of the carotid arteries was studied in 20 cadavers. Micrometric values of the CB and its relation with surrounding structures, measurements belonging to the external carotid artery (ECA) and internal carotid artery (ICA), and metric data, such as lower face including the greater horn, laryngeal prominence have been evaluated by making linear measures. The diameter of the CCA at the CB under 2 cm and CB diameter was measured as 8.1 +/- 2.24 mm and 12.79 +/- 2.87 mm, respectively. Evaluating data related to the ICA and the ECA in samples, the aspect was measured the ICA and the ECA in the CB discrimination point as 21.52 +/- 20.53 degrees . In the most location of the ECA origin according to the ICA has been determined as medial position in 35 specimens. The origin of the superior thyroid artery (STA) was found to be at the same level with the CB in 40% and below it in 25% specimens. This study has provided measured objective criteria for the arterial features of the neck region, which are crucial during surgery. The origins of the branches of the CCA act as key landmarks for adequate and appropriate placement of the cross-clamp on the carotid arteries.     

Anomalous branch of the left common carotid artery

A previously unreported anomalous branch of the left common carotid artery (LCCA) was observed during dissection at the Zagreb Medical School. The anomalous branch arose from the anterior surface of the LCCA approximately 2 cm superior to the aortic arch, and subsequently bifurcated into a right and left branch. We describe its anatomic features. Clinical implications are also discussed.     

Anastomosis between the internal carotid and vertebral artery in the neck

Summary We report a case of anastomosis between the internal carotid and vertebral a. in the cervical region. This anatomic variation is due to incomplete migration during embryogenesis of the branchial aa., collaterals of the dorsal aorta, towards the ventral aorta. It does not involve persistence of a type I proatlantal a., as described by Lasjaunias. Such anastomoses must be recognised since they may modify surgical tactics in the context of endarterectomy for carotid stenosis.

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Anastomose entre l'artère carotide interne et l'artère vertébrale à l'étage cervical

Résumé Nous rapportons un cas d'anastomose entre l'artère carotide interne et l'artère vertébrale à l'étage cervical. Cette variation anatomique est due à la migration incomplète, au cours de l'embryogénèse, des artères branchiales, collatérales de l'aorte dorsale, vers l'aorte ventrale. Il ne s'agit pas de la persistance d'une artère proatlantale type I comme l'avait décrit Lasjaunias. De telles anastomoses doivent être reconnues et peuvent modifier la tactique chirurgicale dans le cadre des endartériectomies de sténoses carotidiennes.

     

The diameters of common carotid artery and its branches in newborns

The common carotid artery (CCA) bifurcation is of clinical importance due to its vascular access site for intravascular intervention. Additionally, it is also one of the most common sites of atherosclerotic plaque formation. There are numerous studies on the diameters of CCA, internal carotid artery (ICA), and external carotid artery (ECA) in adults, but few studies on newborns. Cadaver and angiographic studies have shown dimensional variations in the carotid arteries within/between individuals and also between different sexes. It is well known that the initial lesions of atherosclerosis begin very early in fetal life. Therefore, it is important to know the anatomical details of the CCA and its branches. In the present study, the neck regions of 20 (11 males and 9 females) fixed newborn cadavers were dissected. The CCAs were cut below the bulb of the carotid bifurcation further; ICA and ECA were cut above the bulb of the carotid bifurcation. The internal diameters of the CCA, ICA, and ECA were measured using a light microscopy. ECA/CCA, ICA/CCA, ICA/ECA ratios, and outflow to inflow area ratio were calculated. The mean outflow to inflow area ratio was 1.14±0.28. Our results highly correlated with the defined optimal ratio (1.15). The ECA/CCA, ICA/CCA, and ICA/ECA ratios were 0.78±0.12, 0.71±0.13, and 0.93±0.16, respectively. There were no statistically significant differences between male and female and also between right and left sides. These findings are of importance in understanding the anatomy of carotid artery during newborn period.     

颈内动脉海绵窦段分支及分布的显微解剖

目的 :为海绵窦的直接手术提供显微解剖学基础。方法 :采用 48侧成人新鲜海绵窦标本 ,颈内动脉灌注苯乙烯 (ABS) ,然后在手术显微镜下解剖观察。结果 :脑膜垂体干出现率为 10 0 % ,脑膜垂体干可分为两型 ,典型的脑膜垂体干出现率为 5 8.3 % ,非典型的脑膜垂体干又分为单干型和非单干型 ,前者出现率为 3 1.3 % ,后者为 10 .4%。海绵窦下动脉出现率为 95 .8% ,垂体被囊动脉为 3 1.3 %。另外眼动脉的出现率为 10 .4%。两侧颈内动脉海绵窦段分支之间的吻合 ,提供了重要的侧支循环血液供应。结论 :本文对颈内动脉海绵窦段分支的显微解剖结果 ,对临床显微外科、血管介入、影像学有指导意义。     

颈内动脉扭曲危险因素的研究

目的：探讨颈内动脉（ ICA ）扭曲与血管危险因素之间的关系。方法回顾性分析2013年6月-2014年1月接受DSA或头颈部CTA检查的87例患者的临床资料。按ICA有无扭曲分为扭曲组（40例）和对照组（47例）,对比两组患者的年龄、性别以及高血压病、糖尿病、高脂血症、缺血性心脑血管病、吸烟史等危险因素与ICA扭曲的相关性。结果两组患者在性别、吸烟史以及糖尿病、高脂血症以及缺血性心脑血管病患病率等方面比较,差异均无统计学意义（P值均〉0.05）;扭曲组患者年龄、高血压病患病率均大于对照组,差异均有统计学意义（P值均〈0.05）。多因素Logistic回归分析结果显示,年龄和高血压病与ICA扭曲的发生具有相关性。结论年龄和高血压病是ICA扭曲发生的危险因素,可能参与了ICA扭曲的发生发展过程。     

Anomalous branching pattern of external carotid artery: Clinical relevance to cervicofacial surgery

Anomalous branching pattern of the left external carotid artery (ECA) was detected in an old man. The ECA branched into high submental artery and large transverse facial artery ending as angular artery compensating for concurrent agenesis of ipsilateral facial artery. The lingual artery gave direct branch to the submandibular gland, whereas the superior thyroid artery arose directly from common carotid artery with high bifurcation level. This unreported branching pattern of the ECA may have important clinical relevance to cervicofacial surgery.     

颈动脉的形态与动脉粥样硬化的解剖学观测

目的研究颈动脉的形态与动脉粥样硬化的情况,为颈总、颈内动脉狭窄的诊治提供形态学基础。方法解剖观测成尸30(男24、女6)侧颈动脉,观测颈动脉的形态及动脉粥样硬化情况。结果①颈总动脉中段外径,左侧(8.75±1.56)mm;右侧(8.31±0.99)mm。②颈内动脉根部外径,左侧(8.15±1.42)mm;右侧(7.51±1.63)mm。③颈外动脉中段外径,左侧(4.87±1.09)mm;右侧(4.39±0.89)mm。④颈动脉粥样硬化发生率占60%(18侧),其中颈内动脉根部四壁明显动脉硬化,内腔直径1.6mm严重狭窄1侧,占总数的3.33%。结论颈动脉粥样硬化发生率最高为颈动脉窦,占颈动脉硬化标本的100%,可致颈内动脉内腔狭窄。     

Complete persistence of the hyoido-stapedial artery in man

Summary The authors report a case of total persistence of the hyoïdo-stapedial artery (HSA) discovered fortuitously in an adult. The external carotid artery terminated as the superficial temporal, middle deep temporal and transverse facial arteries; the HSA arose from the intrapetrous internal carotid artery, coursed within the middle ear and the middle cranial fossa where it gave off the middle meningeal artery before leaving the skull via the foramen spinosum to become the maxillary artery.

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Persistance complète de l'artère hyoïdo-stapédienne chez l'homme: à propos d'un cas (origine carotidienne intrapétreuse de l'artère maxillaire)

Résumé Les auteurs rapportent un cas de persistance totale de l'artère hyoïdo-stapédienne (AHS) de découverte fortuite chez un adulte. L'artère carotide externe se termine en artère temporale superficielle, temporale moyenne profonde et transverse de la face; l'AHS naît de la carotide interne intrapétreuse, chemine à l'intérieur de l'oreille moyenne et de la fosse cérébrale moyenne où elle abandonne l'artère méningée moyenne avant de quitter le crâne en passant par le trou petit rond pour devenir l'artère maxillaire.

     

Aberrant petrous internal carotid artery with cochlear anomaly-an unusual association

The magnetic resonance imaging (MRI) in a female patient who presented with headache and hearing loss revealed aberrant course of the petrous segment of internal carotid artery (ICA). Computed tomography (CT) of the temporal bone done to confirm the findings of MRI revealed aberrant course of right ICA, a persistent stapedial artery (PSA) and absent foramen spinosum on the same side. In addition patient had a cystic cochleovestibular anomaly on the right side with both conditions may probably be contributing to her hearing loss.     

Intracavernous branches of the internal carotid artery (ICA)

Summary Since we started to work in the lateral sellar region (in 1973), a large volume of angiographic material has provided us with exceptional variations that added to the anatomic facts obtained from our dissections. At present, these anatomic facts remain, but the way we look at them and the way we use them for endovascular treatments, has created a need for a different type of approach and understanding.In this report, we present a flexible anatomical view of the intracavernous branches of the internal carotid artery and a scheme to understand and predict the anatomical variations of these collaterals. Four embryonic vessels play an important role in the variations of the arterial supply to the lateral cavernous region: the dorsal ophthalmic artery, the stapedial artery, the trigeminal artery and the primitive maxillary artery. In general each of them partially regresses leaving behind a remnant. However there is a spectrum from their persistence to incomplete regression, resulting in variations of the supply to their distal territories. The term meningohypophyseal should be abandoned because it is misleading and improperly used.Complete agenesis is known for a long time; in case of segmental agenesis of the ICA each of the embryonic vessels presented above may represent an alternate route to bypass the agenesis. The ICA is not a direct feeding artery but a succession of independant segments which can be the site of various anomalies. An embryonic transdural circle can be individualized; it is constituted by the trigeminal arteries posteriorly, the ICA siphon anteriorly, the transsellar anastomosis and internal maxillary artery connections. Although regressions usually occur in this embryonic transdural circle, its derivatives congenital and acquired arterial pathologies. It also constitutes the key system in determining the arterial variations of the perisellar region.

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Collatérales intra-caverneuses de la carotide interne:Synthèse de leurs variations

Résumé Depuis que nous avons commencé notre travail, sur la région latéro-sellaire (en 1973), une grande quantité d'angiographies sélectives de variations vasculaires est venue compléter le matériel anatomique que nous avions obtenu à partir des dissections. Aujourd'hui les faits anatomiques observés restent, mais la faÇon dont nous les regardons et la manière dont nous les utilisons pour nos traitements endovasculaires nécessitent une vision et une présentation différente de ces variétés.Dans cet article, nous proposons une vision anatomique « flexible » des branches intra-caverneuses de la carotide interne à partir d'un schéma générique permettant de comprendre et de prédire les variations de ces collatérales. 4 vaisseaux embryonnaires jouent un rÔle clé dans le déterminisme des variations artérielles de cette région: l'artère ophtalmique dorsale, l'artère stapédienne, l'artère trijéminée et l'artère maxillaire primitive. En général, chacune d'entre elles régresse partiellement, laissant derrière elle un reliquat artériel. En fait, il existe toute une gamme possible, entre la persistance du vaisseau embryonnaire et le reliquat; chacun de ces intermédiaires, crée une variation dans le territoire de vascularisation de ces artères. Ainsi le terme de tronc méningo-hypophysaire devrait Être abandonné car il est source de confusion et utilisé la plupart du temps de faÇon anatomiquement impropre.De mÊme, l'agénésie complète de la carotide interne est connue depuis longtemps; mais en cas d'agénésie incomplète de la carotide interne chacun des vaisseaux embryonnaires présentés ci-dessus constitue une voie de suppléance, court-circuitant le segment agénatique. La carotide interne ne doit pas Être considérée comme une artère nourricière proprement dite mais comme une succession de segments indépendants pouvant Être le siège d'anomalies multiples mais spécifiques. Enfin, on peut donc décrire, un cercle embryonnaire trans-dural constitué par les artères trijéminées en arrière, les siphons carotidiens en avant, l'anastomose trans-sellaire sur la ligne médiane et les anastomoses maxillaires internes en dehors. Bien que chacun des éléments de ce cercle embryonnaire régresse au cours du développement, ces reliquats constituent en pratique des voies accessoires fournissant la circulation collatérale efficace aussi bien dans les anomalies congénitales qu'acquises du tronc artériel carotidien interne. Ce cercle artériel embryonnaire constitue le système clé du déterminisme des variétés artérielles de la région péri-sellaire, ses variétés sont indépendantes de celles du cercle de Willis.

     

颈内动脉床突段的解剖特点及毗邻关系

目的　观察颈内动脉床突段的解剖特点,探讨该结构的毗邻关系,为临床工作的开展提供依据。 方法　成人尸头标本7例,分别以红色和蓝色硅胶对动脉、静脉进行灌注;应用显微解剖技术,观察并测量颈内动脉的床突段及与眼动脉、远/近侧硬膜环等重要毗邻结构的位置关系。 结果　(1)与颈内动脉床突段相关的参数：床突段的外径为（5.11±0.81）mm,床突段外侧面远、近侧硬膜环中点间距离为（5.46±1.90）mm,远侧硬膜环形成颈内动脉窝的出现率约为78.6%。(2）床突段与眼动脉的关系：①眼动脉起点与远侧硬膜环的位置关系为近侧约7.1%、恰于远环处约14.3%、远侧78.6%;②眼动脉起点与颈内动脉横截面的位置关系为内1/3约78.6%、中1/3约21.4%（未观察到外1/3的情况）。 结论　(1)术前影像学检查十分必要。(2)对侧翼点入路有利于眼动脉起点处病变的暴露。(3)提出两点术中注意事项：①环切远侧硬膜环时,应注意避免伤及眼动脉或其它视神经管内结构;②磨除前床突时注意其内侧的重要血管、神经组织,应以邻近硬膜瓣加以保护。