CISTERNAL

RING
SPHENOID
SELLAR
GASSERIANCLIVAL
PETROUS
COCHLEAR

Seven ICA Segments Defined. 3D Diagram (Left). DSA Lateral Angiogram (Right).

Abdulrauf, et al, Proposed clinical internal carotid artery classification system J Craniovertebr Junction Spine.
Year: 2016 | Volume: 7 | Issue Number: 3 | Page: 161-170

Distal Dural
Ring

3rd Nerve

4th Nerve

CISTERNAL
RING

Meningohypophyseal
Trunk

SPHENOID
SELLAR

Petrolingual
Ligament

GASSERIANCLIVAL

Eustachian Tube

PETROUS

COCHLEAR

Base of the Styloid Process

and Stylomastoid Foramen
Transition Landmarks Between the ICA Segments: Right ICA (AP View) Showing
Transition Landmarks in Blue.
Abdulrauf, et al, Proposed clinical internal carotid artery classification system J Craniovertebr Junction Spine.
Year: 2016 | Volume: 7 | Issue Number: 3 | Page: 161-170

3rd Nerve
CISTERNAL
4th

Nerve

5th Nerve

RING

6th Nerve

SPHENOID

Petrolingual
Ligament

SELLAR

Vidian Canal

Eustachian
Tube

GASSERIANCLIVAL
PETROUS

COCHLEAR
Cochlea

ICA Segments Relationship to the Cranial Nerves. Right ICA AP View (left) and Lateral View (Right)

Abdulrauf, et al, Proposed clinical internal carotid artery classification system J Craniovertebr Junction Spine.
Year: 2016 | Volume: 7 | Issue Number: 3 | Page: 161-170

CISTERNAL
Sphenoid
Sinus

RING
SPHENOID

Clivus
SELLAR

Vidian Canals

Eustachian
Tubes

GASSERIANCLIVAL
PETROUS

COCHLEAR

For Anterior Endoscopic Approaches: the Relationship of the Segments to the

Eustachian Tubes and the Vidian Canals. Both ICAs Depicted Diagrammatically
in AP View.

Abdulrauf, et al, Proposed clinical internal carotid artery classification system J Craniovertebr Junction Spine.
Year: 2016 | Volume: 7 | Issue Number: 3 | Page: 161-170

CISTERNAL
RING
SPHENOID
SELLAR
GASSERIANCLIVAL
PETROUS

COCHLEAR
Vidian Canals

For Anterior Endoscopic Approach: Vidian Canal at Transition Point from Petrous to
Gasserian-Clival ICA.

Abdulrauf, et al, Proposed clinical internal carotid artery classification system J Craniovertebr Junction Spine.
Year: 2016 | Volume: 7 | Issue Number: 3 | Page: 161-170

Classification System Impact of Identifying Structures at Risk

Surgical approach

Structure at risk

Total Petrosectomy

Cochlear ICA Segment

Extradural Middle Fossa Dissection/Drilling Lateral to the ICA

ET

Drilling the Petrous Apex

Petrous ICA Segment

Endoscopic Dissection/Drilling at the Proximal Vidian Canal

Petrous-Gasserian ICA Junction

Endoscopic Drilling Lateral to the Vidian Canal

Petrous ICA Segment

Endoscopic Drilling Superior to the Vidian Canal

Gasserian ICA Segment

Anterior Microsurgical or Endoscopic Drilling/ Dissection at Lateral Edge of Clivus

Gasserian ICA Segment

Microsurgical Dissection in Meckels Cave

Gasserian ICA Segment

Endoscopic or Microsurgical Dissection in the Sella

Sellar ICA Segment

Endoscopic or Microsurgical Dissection/Drilling in the Sphenoid Sinus

Sphenoid ICA Segment

Drilling of Anterior Clinoid and Opening of Proximal Dural Ring

Third Cranial Nerve

ICA - Internal Carotid Artery; ET - Eustachian Tube

Abdulrauf, et al, Proposed clinical internal carotid artery classification system J Craniovertebr Junction Spine.
Year: 2016 | Volume: 7 | Issue Number: 3 | Page: 161-170