-
Harmona Abonales posted an update in the group
MT 30 – IJ (LEC) 3 years, 7 months ago The distal dural ring or DDR is a protected intracranial anatomic feature that marks the point where the internal carotid artery (ICA) leaves the cavernous sinus (CS) and into the subarachnoid space. Despite the fact that the CS has been well documented in a variety of anatomic investigations, no previous work has looked at the histologic link between the ICA and DDR. The goal of this research was to analyze the DDR’s connection to the ICA and establish whether it can be dissected from the ICA and therefore partitioned, or if it can simply be circumferentially cut around the artery.
The specimen used were from 10 cadavers that were fresh-frozen. The procedure included a typical frontotemporal craniotomy, orbito-optic osteotomy, and bilateral extradural anterior clinoidectomy. The collected specimens were the cavernous ICA, DDR, as well as the supraclinoid ICA. These specimens were fixed with formalin and embedded in paraffin and stained with hematoxylin and eosin, and Masson trichome.
Histology of the distal dural ring – PubMedThe distal dural ring (DDR) is a conserved intracranial anatomic structure marking the boundary point at which the internal carotid artery (ICA) exits the cavernous sinus (CS) and enters the subarachnoid space. Although the CS has been well described in a range of anatomic studies, to our knowledge …-
In intricate cranial surgery, such as skull base and cerebrovascular surgeries that may need the mobilization of the ICA at the DDR level, understanding the microscopic connectivity of these components is highly relevant. Several reputable neurosurgical atlases propose that the DDR can be dissected free of the ICA and divided. However, this has not been done in current clinical experiences. In this study, the authors intended to analyze the exact histologic interface of the ICA and DDR which would be a useful discovery for safe surgical strategies in performing such a dissection. -
Results show that The DDR cannot be safely cut free from the ICA adventitia, according to the histologic findings of the study. Instead, the DDR should be cut circumferentially, leaving a 2mm cuff of DDR on the ICA to ensure safe clinoidal segment movement and reduce the risk of arterial damage.
-
Recognizing the anatomic connections around the clinoidal ICA, as well as how these new findings serve as technical recommendations for ICA mobilization at the CS and DDR, is crucial for interpreting this novel discovery. Results reveal a significant collagen network that connects the adventitia of the ICA with the DDR, with long, ubiquitous, and abundant fibers physically interweaving the two structures. The anatomical connectivity between the DDR and the ICA has important clinical implications for microneurosurgery. ICA mobilization is required for surgeries like cutting carotid-ophthalmic aneurysms or removal of certain parasellar and anterior clinoid neoplasms.
-
The circulatory system is indeed an intricate and complex structure to the microscopic level. Its mechanism is best understood by observing and analyzing histological anatomy and physiology. Because of the perseverance of the investigators of this study, another novel discovery is presented which could help answer questions that current surgeons have. With further studies and practice of the recommended techniques, this may be well-adopted in the clinical setting.
-
Recently Active Members
