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Objective: Variations of the cavernous Internal Carotid Artery (ICA) angulation (C4-bend) have been classified into 4 anatomical subtypes with particular surgical relevance, as a very angulated ICA comes in closest contact with the pituitary gland leading to higher risk of iatrogenic vascular injury. This study aimed to validate this classification using current routine imaging techniques.
Methods: The different cavernous ICA bending angles were measured on 109 MRI TOF sequences, within a retrospective database of patients with no sellar lesions. Each ICA was classified into one of 4 anatomical subtypes as already defined in a previous study [1]. Interrater agreement was assessed by a Kappa Correlation Coefficient.
Results: Kappa Correlation Coefficient was of 0.90 [0.82-0.95], validating the strong level of agreement between all observers when using the present classification.
Conclusion: Classification of the cavernous ICA in 4 subtypes appears statistically valid on routinely used pre-operative MRI, providing an efficient tool to estimate the vascular iatrogenic risk prior to endoscopic endonasal transsphenoidal surgery.
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http://dx.doi.org/10.1016/j.clineuro.2023.107647 | DOI Listing |
Folia Morphol (Warsz)
July 2025
Ankara Etlik City Hospital, Varlık Mahallesi, Halil Sezai Erkut Caddesi Yenimahalle, Ankara, Türkiye.
Background: Congenital anomalies of the internal carotid artery (ICA) are rare and often asymptomatic, posing diagnostic and clinical challenges during surgical or endovascular procedures. This study aimed to assess the incidence and features of ICA agenesis, hypoplasia, and fenestration in patients undergoing carotid CT angiography (CTA).
Materials And Methods: Following ethics approval, a retrospective review of 1950 carotid CTA scans performed between January 2023 and January 2024 was conducted.
Surg Radiol Anat
July 2025
Department of Anatomy, Faculty of Health Sciences, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias str., Goudi, 11527, Athens, Greece.
Variations of the cerebral arterial circle are frequently observed due to the progressively increasing utilization of diagnostic imaging techniques. Among these variations, the persistence of embryonic vessels, such as the persistent trigeminal artery (PTA), is rare yet holds significant clinical relevance. This presentation details a distinctive case of the PTA coexisting with a partial duplication of the anterior communicating artery (AComA), as identified through magnetic resonance angiography (MRA) in a 41-year-old female patient.
View Article and Find Full Text PDFNeurology
August 2025
Department of Neurosurgery and Spine Surgery, University Hospital Essen, Germany.
Background And Objectives: Familial cavernous malformations (FCMs) are vascular lesions that pose a lifelong risk of symptomatic hemorrhage (SH) and seizures, yet their natural history remains unclear. This study aims to determine the cumulative lifetime risk of a first SH and/or seizure and assess whether genetic variations influence these risks.
Methods: This international, multicenter retrospective cohort study included data from 16 tertiary referral centers and 1 patient advocacy group.
J Neurosurg
June 2025
1Department of Neurosurgery, Stanford University, Stanford, California.
Objective: The carotidoclinoidal ligament (CCL) spans from the medial wall of the cavernous sinus (MWCS) to the internal carotid artery (ICA) and anterior clinoid process. In endoscopic endonasal transcavernous surgery, safe transection of the CCL requires not only knowledge of its typical anatomy, but also an understanding of its possible variations. The aim of this study was to analyze the anatomical variations of the CCL and the patterns of CCL invasion by pituitary adenomas (PAs).
View Article and Find Full Text PDFSurg Radiol Anat
June 2025
Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527, Athens, Greece.
The cerebral arterial circle displays significant variation, with infrequent configurations often ascertained through contemporary imaging techniques. We present a sporadic case of a duplicated superior cerebellar artery (SCA) discovered during magnetic resonance angiography (MRA) of a 58-year-old female patient. Typical SCA emanates from the distal basilar artery (BA), whereas a duplicate one originates from the pre-cavernous segment of the internal carotid artery (ICA).
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