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Published on: January 17, 2018
Intercarotid artery distance in the pediatric population: Implications for endoscopic transsphenoidal approaches to
Lifeng Li1, Ricardo L Carrau2, Daniel M Prevedello2
1Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Insights
The intercarotid artery distance (ICD) in children narrows significantly up to age 5, particularly at the paraclinoid segment. This pediatric ICD data is crucial for endoscopic endonasal surgery (EEA) planning.
Area of Science:
- Pediatric neuroanatomy
- Skull base surgery
- Medical imaging
Background:
- Quantitative data on pediatric intercarotid artery distance (ICD) is limited.
- Understanding ICD development is vital for pediatric skull base surgery.
Purpose of the Study:
- To quantitatively evaluate the intercarotid artery distance (ICD) at multiple skull base levels in pediatric patients.
- To assess developmental changes in pediatric ICD.
Main Methods:
- Coronal MRI scans from 540 pediatric patients (0-17 years) were analyzed.
- Intercarotid artery distances (ICDs) were measured at paraclival, parasellar, and paraclinoid segments.
- Sphenoid sinus pneumatization was assessed and correlated with age.
Main Results:
- The narrowest ICD was consistently at the paraclinoid internal carotid artery (ICA) segments (89.44%).
- Significant differences in ICD were observed between very young (0-5 years) and older (6-17 years) pediatric groups (p < 0.0001).
- Sphenoid sinus pneumatization begins around age 3 and is complete by age 7 in most children.
Conclusions:
- Pediatric ICD measurements provide essential anatomical references for endoscopic endonasal surgery (EEA).
- While ICD stabilizes after age 5, anatomical variations in younger children (0-5 years) may pose challenges for transsphenoidal access.
Objective:
Comprehensive quantitative evaluation of the intercarotid artery distance (ICD) in the pediatric population has not been sufficiently explored. This study aims to measure the minimal ICDs at multiple levels of the skull base to assess changes in the ICD during development.
Methods:
Measurement of the ICDs between the paired paraclival, parasellar, and paraclinoid segments of the internal carotid artery (ICA) was performed on coronal MRI from 540 patients ranging from 0 to 17 years old (n = 30 for each age). Comparison of these indices in the very young (0-5 years, Group 1) and young (6-17 years, Group 2) patients, and assessment of the degree of sphenoid sinus pneumatization was employed.
Results:
The narrowest ICD was located at the paraclinoid ICAs in the vast majority of cases (89.44%). When comparing the ICDs in very young age patients with the ICDs of 17 years old subjects, a statistically significant difference was found at the paraclival (ages 0-5), parasellar (ages 0-2), and paraclinoid (ages 0-4) ICDs (p < 0.05). Comparison of the ICDs between the intergroups (Group 1 and 2) also demonstrated a statistically significant difference (p < 0.0001). Pneumatization of the sphenoid sinus was initially noted to start at 3 years of age, and there were no patients with a non-pneumatized sphenoid sinus identified after 7 years of age in our cohort.
Conclusion:
Measurement of ICDs at multiple levels provides a valuable reference for EEA procedures in the pediatric population. While the ICD may be largely stable in the pediatric population after 5 years of age, additional anatomic factors may restrict transsphenoidal access in very young patients (0-5 years).
