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<p>The localisation of the parapharyngeal ICA (ppICA) during transpterygoid infra petrous expanded endoscopic endonasal approaches (TIEA) can be difficult since it is in a soft tissue compartment. Hence, we propose to identify the nearby bony structures as landmarks that will further guide ppICA localisation.A retrospective analysis of CT angiograms of 119 patients done between 2010 and 2016 was done by reviewing images on the picture archiving and communication system. On the axial plane image, at the level of the hard palate, the distance between the ppICA and medial pterygoid plate (Mpp), lateral Pterygoid plate (Lpp), anterior tubercle of first cervical vertebrae (C1), posterior margin of the mandible (Man) and styloid process (ST) were noted. These landmarks were utilised along with the navigation system and the Doppler during TIEA and correlated on a cadaver.The mean distance from – Mpp, Lpp, C1 and Man to the ppICA was between 2.0 to 2.5 cm. The mean distance between the ST and ppICA was less than 1 cm. The ppICA was noted to be consistently located in a triangular area bounded by lines connecting the Mpp, ST and C1. The distance from these three structures to ppICA was analysed statistically on the right and left side using a student T-test and this was found to be consistent (p=0.199). This we consider as the ppICA triangle.The consistent relationship of the bony landmarks to the ppICA enables proper orientation, and adequate depth perception and can enable finer ppICA localisation during TIEA.</p>

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A Radiological Guide to the Localization of Parapharyngeal Internal Carotid Artery in Transpterygoid Infrapetrous Expanded Endoscopic Endonasal Approaches

  • 期刊论文

  • 发表日期：

    2026年2月20日

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  • Katti Blessi Sara,
  • Rajan Sundaresan Vediappan,
  • Anitha Jasper,
  • Aparna Irodi,
  • Deepak Vinod Francis,
  • Grace Rebekah,
  • Regi Thomas

摘要

The localisation of the parapharyngeal ICA (ppICA) during transpterygoid infra petrous expanded endoscopic endonasal approaches (TIEA) can be difficult since it is in a soft tissue compartment. Hence, we propose to identify the nearby bony structures as landmarks that will further guide ppICA localisation.A retrospective analysis of CT angiograms of 119 patients done between 2010 and 2016 was done by reviewing images on the picture archiving and communication system. On the axial plane image, at the level of the hard palate, the distance between the ppICA and medial pterygoid plate (Mpp), lateral Pterygoid plate (Lpp), anterior tubercle of first cervical vertebrae (C1), posterior margin of the mandible (Man) and styloid process (ST) were noted. These landmarks were utilised along with the navigation system and the Doppler during TIEA and correlated on a cadaver.The mean distance from – Mpp, Lpp, C1 and Man to the ppICA was between 2.0 to 2.5 cm. The mean distance between the ST and ppICA was less than 1 cm. The ppICA was noted to be consistently located in a triangular area bounded by lines connecting the Mpp, ST and C1. The distance from these three structures to ppICA was analysed statistically on the right and left side using a student T-test and this was found to be consistent (p=0.199). This we consider as the ppICA triangle.The consistent relationship of the bony landmarks to the ppICA enables proper orientation, and adequate depth perception and can enable finer ppICA localisation during TIEA.