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Journal articles on the topic 'Carotid tubercle'
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Eyenga, Victor-Claude, Ignatius N. Esene, Ernestine A. Bikono, and Ngah J. Eloundou. "Treatment of Cervical Spine Fractures and Subluxations without the Use of Intraoperative Fluoroscopy in Resource-Limited Settings." Journal of Neurosciences in Rural Practice 11, no. 01 (2020): 160–63. http://dx.doi.org/10.1055/s-0040-1701369.
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Abstract Background Surgical management of subaxial cervical spine injuries remains challenging. Although intraoperative fluoroscopy is usually used for intraoperative spinal level localization (SLL), it is unavailable in most developing countries. The surgeon therefore has to rely on anatomic landmarks. In our setting, in the absence of intraoperative fluoroscopy, we used the carotid tubercle for SLL. Herein we evaluate the accuracy and reliability of the carotid tubercle as a landmark during surgery for traumatic cervical spine injury. Methods This was a retrospective cohort study on 34 patients undergoing anterior cervical surgery for subaxial cervical spine fractures and/or subluxation between January 2005 and February 2011. From their medical records, the patients’ sociodemographic, clinical, radiological, and operative data were retrieved and analyzed. Results Thirty-four patients were included in the study. The mean age was 36.2 years. Thirty patients were males. The mean duration between the trauma and surgical intervention was 9.6 days. Six patients were completely tetraplegic. Fourteen patients had fractures and 20 patients had subluxation. The carotid tubercle was palpable in all the 34 cases. Twenty-two (68.8%) patients had partial or complete neurologic recovery. Complete anatomic reduction was achieved in 30 cases. One case of slight malalignment of the plate was observed. No case of significant deviation nor penetration of the screw into the vertebral canal was found. One patient died. Conclusions Carotid tubercle, a palpable intrinsic marker, is an attractive anatomic landmark for SLL during surgeries for traumatic spine injuries in resource-limited settings.
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Vipin, Kumar, Reeti Raag, and Prasad Sinha Abhishek. "A Morphological Study of the External Carotid Artery with Reference to Adjacent Anatomical Landmarks in Cadavers." International Journal of Pharmaceutical and Clinical Research 15, no. 2 (2023): 1180–85. https://doi.org/10.5281/zenodo.12828090.
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<strong>Aim: </strong>The aim of this observational study was to establish the relationship of External Carotid Artery with reference to Adjacent Anatomical landmarks in cadavers. <strong>Methods: </strong>The present observational study was done in the Department of Anatomy, Netaji Subhas medical College and Hospital, Bihta, Patna, Bihar, India. 60 hemi-necks obtained from 30 formalin embalmed cadavers (20 male and 10 female) were dissected and the external carotid arteries were traced from the origin to termination. <strong>Results: </strong>The ECA took origin at the level of upper border of thyroid cartilage (TC) in 40/60 cases (66.66%). Higher level of origin was noted in the remaining 20 of 60 cases (33.34%). Higher levels of carotid bifurcation were further categorized keeping the TC as anatomical landmark. No lower levels of origin were noted in this study. The anteromedial position of the ECA relative to the ICA at the level of the carotid bifurcation was noted in all the cases. <strong>Conclusion: </strong>The exact anatomical knowledge of External Carotid Artery with reference to adjacent anatomical landmarks is helpful for surgeons to plan surgeries and prevent complications during various diagnostic and therapeutic procedures.
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Hong, Jae Taek, Tae Hyung Kim, Il Sup Kim, et al. "The effect of patient age on the internal carotid artery location around the atlas." Journal of Neurosurgery: Spine 12, no. 6 (2010): 613–18. http://dx.doi.org/10.3171/2010.1.spine09409.
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Object The aim of this study was to analyze the exact location of the internal carotid artery (ICA) relative to the C-1 lateral mass and describe the effect of age on the tortuosity of the ICA. Methods The authors analyzed 641 patients who had undergone CT angiography to evaluate the location of the ICA in relation to the C-1 lateral mass. Each patient was assigned to 1 of 3 age groups (< 41 years, 41–60 years, and > 60 years of age). The degree of lateral positioning of the ICA was classified into 4 groups: Group 1 (lateral to the C-1 lateral mass), Group 2 (lateral half of the lateral mass), Group 3 (medial half of the lateral mass), or Group 4 (medial to the lateral mass). The anteroposterior relationship of the ICA was classified into Group A (posterior to the anterior tubercle) or Group B (anterior to the anterior tubercle). Distances from the ICA to the midline, anterior tubercle, and anterior cortex of the lateral mass were measured. Distances between the lateral margin of the lateral mass and the longus capitis muscle were also evaluated. Results The prevalence of the ICA located in front of the lateral mass (Groups 2 and 3) was 47.4% overall. The position of the ICA changes with age due to vessel tortuosity. Only 18.3% of patients in the youngest age group (< 41 years of age) had an ICA in front of the lateral mass (Group 2 or 3 area). However, this percentage increased in the older 2 groups (43.5% in the 41–60 year old group, and 57% in the > 60-year-old age group). The mean distance from the midline to the ICA was 22.6 mm, and the mean distance from the ICA to the C-1 anterior tubercle and the ventral cortex of the lateral mass was 4.7 and 4.5 mm, respectively. Moreover, the ICA is more prone to injury during bicortical C-1 screw placement when the longus capitis muscle is hypotrophic and does not cover the entire ventral surface of the lateral mass. Conclusions Elderly patients have a higher incidence of a medially located ICA that may contribute to the risk of injury to the ICA during bicortical C-1 screw or C1–2 transarticular screw placement. Although the small number of reported cases of ICA injury does not allow for determination of a direct relationship with specific anatomical characteristics, the presence of unfavorable anatomy does warrant serious consideration during evaluation for C-1 screw placement in elderly patients.
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Nakashima, Tadashi, Charles P. Kimmelman, and James B. Snow. "Immunohistopathologic Analysis of Olfactory Degeneration Caused by Ischemia." Otolaryngology–Head and Neck Surgery 93, no. 1 (1985): 40–47. http://dx.doi.org/10.1177/019459988509300109.
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The development of olfactory dysfunction caused by ischemia was studied in Mongolian gerbils. Mongolian gerbils frequently have an anomaly of the cerebral circulation and are susceptible to brain ischemia or infarction following ligation of a single common carotid artery. Ischemia was induced by unilateral common carotid artery ligation or temporary occlusion of both common carotid arteries, and the olfactory pathway was examined. In the olfactory pathway of the forebrain, ischemic changes were observed in the lateral olfactory tract, olfactory tubercle, olfactory ventricle, and anterior olfactory nucleus. The olfactory bulb was resistant to ischemia. Partial or complete degeneration of the ipsilateral olfactory neuroepithelium was observed in some gerbils that survived more than 14 days after the onset of ischemia. Immunohistopathologic analysis of the neuroepithelium for the olfactory marker protein revealed that functional damage of the olfactory neurons occurred in some gerbils within the first few days after the ischemic event.
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Ovhal, Anjalee G., K. Ravikumar, and Sachin Badge. "A cadaveric study of relationship of external carotid artery with reference to adjacent anatomical landmarks." Indian Journal of Clinical Anatomy and Physiology 8, no. 4 (2022): 255–59. http://dx.doi.org/10.18231/j.ijcap.2021.056.
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Evaluation of carotid bifurcation level and relationship of External Carotid Artery (ECA) with reference to adjacent anatomical landmarks is important in planning various surgical and radiological procedures related to the carotid arteries. The aim was to study the relationship of External Carotid Artery with reference to Adjacent Anatomical landmarks in cadavers. 60 cadavers - 52 male and 8 female embalmed with 10% formalin were dissected over the period of two years for this study. The distance between the origin and the termination of ECA was found to be in the range of 25–70 mm on the right side and in the range of 25–68 mm on the left side. The distance between the origin of ECA and the carotid tubercle was found to be in the range of 23–50 mm on the right side and in the range of 22–48 mm on the left side. The distance between the origin of ECA and the angle of the mandible was found to be in the range of 18–30 mm on the right side and in the range of 20–32 mm on the left side. The anatomical knowledge of relationship of External Carotid Artery with reference to adjacent anatomical landmarks is helpful for vascular surgeons to plan surgeries and prevent complications during various diagnostic and therapeutic procedures.
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Pallavi, Sahay, Saha Bhawna, and K. Karn S. "Assessing the Association of External Carotid Artery with Reference to Adjacent Anatomical Landmarks: A Cadaveric Study." International Journal of Current Pharmaceutical Review and Research 16, no. 01 (2024): 949–52. https://doi.org/10.5281/zenodo.12795823.
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AbstractAim: The aim of the present study was to study the relationship of External Carotid Artery with reference toAdjacent Anatomical landmarks in cadavers.Methods: The present retrospective study was done in the Department of Anatomy, Darbhanga Medical Collegeand Hospital, Laheriasarai, Darbhanga, Bihar, India from January 2021 to December 2021. 60 hemi-necksobtained from 30 formalin embalmed cadavers (20 male and 10 female) were dissected and the external carotidarteries were traced from the origin to termination.Results: The ECA took origin at the level of upper border of thyroid cartilage (TC) in 40/60 cases (66.66%).Higher level of origin was noted in the remaining 20 of 60 cases (33.34%). Higher levels of carotid bifurcationwere further categorized keeping the TC as anatomical landmark. No lower levels of origin were noted in thisstudy. The anteromedial position of the ECA relative to the ICA at the level of the carotid bifurcation was notedin all the cases.Conclusion: The anatomical knowledge of relationship of External Carotid Artery with reference to adjacentanatomical landmarks is helpful for vascular surgeons to plan surgeries and prevent complications during variousdiagnostic and therapeutic procedures
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Puskas, Laslo, Nela Puskas, Sinisa Babovic, Lazar Velicki, Dejan Ivanov, and Ljilja Mijatov-Ukropina. "C-fos protein expression in the parietal cortex and olfactory tubercle in the hypoxic rat brain." Medical review 60, no. 3-4 (2007): 128–33. http://dx.doi.org/10.2298/mpns0704128p.
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Introduction. We have attempted to identify which parts of the brain react to ischemic attack using the four-vessel occlusion model in rats. Material and methods. We have monitored the expression of c-fos protein in the parietal cortex (R3 and T3) and in the olfactory tubercle (R4 and T4), regions which are supplied with blood by different arteries. The four-vessel occlusion was performed using the Pulsinelli?s method and rats were divided into two groups: total ischemia (ligation of four blood vessels or coagulation of the vertebral artheries with bilateral ligation of carotid arteries - R group) and transient ischemic attack (ligation of four blood vessels or coagulation of the vertebral arteries with bilateral repeated ligation of carotid arteries - T group of rats, the so- called preconditioned group). Each of these groups had a control group. Results and conclusion. The results showed pronounced expression of c-fos neurons in T group of rats which can explain longer survival of neurons. We believe that this model can serve as a good starting point to developing new approaches to the therapy of brain ischemia.
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Das, Dibangkar, Vikas Sharma, S. Hari Kumar, V. Bala Krishnan, Nisha Kumari, and Zia Zafar. "Aberrant branching pattern and uncommon origin of inferior thyroid artery - dual rarity." International Journal of Otorhinolaryngology and Head and Neck Surgery 11, no. 3 (2025): 278–80. https://doi.org/10.18203/issn.2454-5929.ijohns20251512.
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Thyroid surgery is one of the most common neck procedures, and surgeons need to have a thorough understanding of the blood supply to this gland to prevent significant haemorrhage. In this report, we describe an aberrant branching pattern of the inferior thyroid artery (ITA) on the right side during a total thyroidectomy performed for papillary carcinoma of the thyroid with retrosternal extension at the ENT-HNS department of Command Hospital (Eastern Command). The left inferior thyroid artery appeared normal. The aberrant ITA originated from the right common carotid artery (CCA). Shortly after its origin, the aberrant branch ascended alongside the middle thyroid vein and entered the thyroid gland near the tubercle of Zuckerkandl. The superior thyroid arteries showed no unusual distribution. This uncommon origin and aberrant branching pattern is extremely rare, and PubMed review found no articles on this specific variation. Understanding such dual rarities and aberrant arterial patterns related to the thyroid gland is invaluable for surgeons, helping to prevent unnecessary haemorrhage.
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Roth, Jonathan, Ameet Singh, Gurston Nyquist, et al. "THREE-DIMENSIONAL AND 2-DIMENSIONAL ENDOSCOPIC EXPOSURE OF MIDLINE CRANIAL BASE TARGETS USING EXPANDED ENDONASAL AND TRANSCRANIAL APPROACHES." Neurosurgery 65, no. 6 (2009): 1116–30. http://dx.doi.org/10.1227/01.neu.0000360340.85186.7a.
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Abstract OBJECTIVE Endoscopic endonasal approaches provide an access method to the midline cranial base. To integrate these approaches into neurosurgical practice, the extent of their anatomic exposure must be compared with that provided by more traditional transcranial approaches. METHODS Ten fresh cadaver heads were studied. Both endonasal and transcranial approaches to the midline cranial base were performed. The midline cranial base was divided into several areas, and the relative exposure provided by each approach was described and presented in both 2-dimensional and 3-dimensional images. Limitations and advantages of each approach are discussed. RESULTS The endonasal approaches achieved a direct and wide exposure of the midline extracranial and intracranial cranial base anatomy. The main lateral limitations of the endonasal approaches were the optic nerves, lateral cavernous sinus, vidian nerve, internal carotid artery, abducens nerve in Dorello's canal, jugular tubercle, and hypoglossal canals. Limitations of the transcranial approaches were the neurovascular structures which lie in the operative corridor and create narrow working spaces. CONCLUSION The endonasal approaches achieve a direct and wide exposure of the midline cranial base bilaterally. Lateral exposure, beyond the cranial nerves and carotid artery, are challenging. Transcranial approaches are limited by the narrow corridors provided by the cranial nerves, and they do not visualize the contralateral paramedian cranial base very well. Three-dimensional endoscopes augment the spatial orientation and may improve patient safety and the learning curve for endoscopic approaches to the midline cranial base.
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Xu, Yuanzhi, Benjamin K. Hendricks, Maximiliano Alberto Nunez, Ahmed Mohyeldin, Juan C. Fernandez-Miranda, and Aaron A. Cohen-Gadol. "Microsurgical Anatomy of the Endoscopy-Assisted Retrosigmoid Intradural Suprameatal Approach to the Meckel's Cave." Operative Neurosurgery 21, no. 2 (2021): 41–47. http://dx.doi.org/10.1093/ons/opab096.
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Abstract BACKGROUND Understanding the microsurgical anatomical features of the endoscopy-assisted retrosigmoid intradural suprameatal approach (RISA) is critical for surgeons treating petroclival tumors or lesions in the cerebellopontine region that extend into Meckel's cave. OBJECTIVE To evaluate increased exposure for Meckel's cave in the RISA and assess the surgical landmarks for this approach. METHODS A standard retrosigmoid craniotomy to the cerebellopontine region was performed in 4 cadaveric specimens (8 hemispheres) with microscope-assisted endoscopy. The length and depth of the drilling region from the suprameatal tubercle to the petrous apex were analyzed. After opening Meckel's cave and mobilizing the trigeminal root completely, the landmarks for this approach were investigated. RESULTS The endoscopy-assisted RISA facilitates mobilization of the trigeminal root and enhances surgical exposure in the region of Meckel's cave and the petrous apex with increases of 10.1 ± 1.3 mm in depth, 21.4 ± 3.2 mm in length, and 6.4 ± 0.6 mm in height. The posterior and superior semicircular canals, internal auditory canal, superior petrous sinus, and internal carotid artery (petrous segment) served as important landmarks for this approach. One case illustration is presented to describe the application of this approach. CONCLUSION The RISA is suitable mainly for lesions in the posterior fossa that extend into Meckel's cave. The endoscopy-assisted reach optimizes accessibility to the petrous apex region, obviates the need for extensive drilling, and decreases the risk of internal carotid artery injury. Better realization and recognition of microsurgical landmarks and parameters of this approach are crucial for successful outcomes.
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Vilela, Marcelo D., and Robert C. Rostomily. "Temporomandibular Joint-preserving Preauricular Subtemporal-Infratemporal Fossa Approach: Surgical Technique and Clinical Application." Neurosurgery 55, no. 1 (2004): 143–54. http://dx.doi.org/10.1227/01.neu.0000126939.20441.dc.
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Abstract OBJECTIVE: The preauricular subtemporal-infratemporal (PSI) approach is commonly used to resect clival tumors and other lesions anterior to the brainstem. One of the surgical steps in this approach is a condylar osteotomy or a condylectomy, which often leads to temporomandibular joint dysfunction. We describe a modification of the PSI approach that preserves the temporomandibular joint without sacrificing the ability to mobilize the petrous internal carotid artery or gain surgical access to the clivus and anterior brainstem. METHODS: Anatomic studies in cadaveric specimens were performed, and the extent of exposure of critical skull base and intradural structures was documented with postdissection fine-cut computed tomographic scans. This modification of the PSI approach was subsequently used in three consecutive patients with a clival chondrosarcoma, and the completeness of tumor resection was documented with postoperative magnetic resonance imaging and computed tomographic scans. RESULTS: This approach allowed complete mobilization of the petrous internal carotid artery and surgical access to the mid-lower clivus, jugular tubercle, hypoglossal canal, occipital condyle, anterior brainstem, and the origin of the trigeminal through hypoglossal nerves. It also proved to be safe and feasible in the three patients who underwent surgical resection of a clival chondrosarcoma, allowing a complete tumor removal. CONCLUSION: This variation of the PSI approach is practical, has no additional morbidity, and provides complete access to critical cranial base regions and tumor margins. It can certainly be used as an alternative to the standard PSI approach when dealing with clival tumors and other lesions anterior to the brainstem.
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Burgos-Sosa, Erik, Jose J. Julian-Mendoza, J. Stephan Sanchez-Torrijos, Lorena Valencia-Caballero, Mario A. Taylor-Martínez, and Agustín Dorantes-Argandar. "The Lateral Pharyngeal Tubercle as a Key Landmark to Estimate Approximation of Neurovascular Structures (Internal Carotid Artery + Lower Cranial Nerves)." Journal of Neurological Surgery Part B: Skull Base 86, S 01 (2025): S1—S576. https://doi.org/10.1055/s-0045-1803610.
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Funaki, Takeshi, Toshio Matsushima, Maria Peris-Celda, Rowan J. Valentine, Wonil Joo, and Albert L. Rhoton. "Focal Transnasal Approach to the Upper, Middle, and Lower Clivus." Operative Neurosurgery 73, no. 2 (2013): ons155—ons191. http://dx.doi.org/10.1227/01.neu.0000431469.82215.93.
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Abstract BACKGROUND: Carefully tailoring the transclival approach to the involved parts of the upper, middle, or lower clivus requires a precise understanding of the focal relationships of the clivus. OBJECTIVE: To develop an optimal classification of the upper, middle, and lower clivus and to define the extra and intracranial relationships of each clival level. METHODS: Ten cadaveric heads and 10 dry skulls were dissected using the surgical microscope and endoscope. RESULTS: The clivus is divided into upper, middle, and lower thirds by 2 endocranial landmarks: the dural pori of the abducens nerves and the dural meati of the glossopharyngeal nerves. Useful surgical landmarks exposed in the transnasal approach that aid in locating the junction of the clival divisions are the lower limit of the paraclival segment of the internal carotid artery, which is located 4.9 mm above the posterior opening of the vidian canal, and the pharyngeal tubercle. The upper, middle, and lower clival approaches provide access to the anterior midline parts of the previously described upper, middle, and lower neurovascular complexes in the posterior fossa. The nasal and nasopharyngeal relationships important in expanding the transnasal approach to the borders of the clivus are reviewed. CONCLUSION: The transclival approach can be carefully tailored to expose focal lesions in the anterior part of the posterior fossa.
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Tanaka, Kortaro, Fumio Gotoh, Shintaro Gomi, Shutaro Takashima, and Ban Mihara. "Autoradiographic Analysis on Second-Messenger Systems and Local Cerebral Blood Flow in Ischemic Gerbil Brain." Journal of Cerebral Blood Flow & Metabolism 11, no. 2 (1991): 283–91. http://dx.doi.org/10.1038/jcbfm.1991.60.
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Alterations of the second-messenger systems, adenylate cyclase (AC) and protein kinase C (PKC), and local cerebral blood flow (1CBF) were evaluated during experimental cerebral ischemia in gerbils employing a quantitative autoradiographic method, which permitted these three parameters to be measured in the same brain. Ischemia was induced by occlusion of the right common carotid artery for 6 h. Animals attaining more than 5 in their ischemic scores were utilized for further experiments. At the end of ischemia, 1CBF was measured by the [14C]iodoantipyrine method. The AC and PKC activities were estimated by the autoradiographic technique developed in our laboratory using [3H]forskolin (FK) and [3H]phorbol-12,13-dibutyrate (PDBu), respectively. The 1CBF fell below 10 ml/100 g/min in most cerebral regions on the ligated side. The greatest reduction in FK binding was noted in the olfactory tubercle, caudate-putamen, and globus pallidus, followed by the hippocampus and cerebral cortices. The FK binding tended to be low at 1CBF < 20 ml/100 g/min in the cerebral cortices. However, the PDBu binding was relatively well preserved in each cerebral structure, and no significant correlation between 1CBF and PDBu binding was noted in the cerebral cortices. The AC system may thus be vulnerable to ischemic insult over extensive brain regions, while the PKC system may be relatively resistant to ischemia.
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Bruneau, Michaël, and Bernard George. "The Juxtacondylar Approach to the Jugular Foramen." Operative Neurosurgery 62, suppl_1 (2008): ONS75—ONS81. http://dx.doi.org/10.1227/01.neu.0000317375.38067.55.
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Abstract Objective: We sought to describe the juxtacondylar approach to jugular foramen tumors. Methods: Through an anterolateral approach, the third segment of the vertebral artery (between C2 and the dura mater) is controlled. The C1 transverse process of the atlas, which is located just inferiorly to the jugular foramen, is then removed. The dissection of the internal jugular vein is performed as high as possible, with control of the IXth, Xth, XIth, and XIIth cranial nerves. If required by a tumor extending into the neck, the internal and external carotid arteries can be exposed and controlled. Through a partial mastoidectomy and after removal of the bone covering the jugular tubercle, the end of the sigmoid sinus and then the posteroinferior part of the jugular foramen are reached. RESULTS: This technique is efficient to expose tumors extending into the jugular foramen. Contrary to the infratemporal approach, it has the main advantage of avoiding petrous bone drilling and associated potential complications. Lower cranial nerves are well exposed in the neck. In patients with schwannomas, complete resection with selective dividing of only the few involved rootlets can be achieved. Conclusion: The juxtacondylar approach is an efficient approach to tumors located in the jugular foramen. It necessitates control of the third segment of the vertebral artery but has the advantage of avoiding complications associated with petrous bone drilling. Extension beyond the jugular foramen requires combination with an infratemporal or a retrosigmoid approach.
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Lee, Jae Hyup, Ji-Ho Lee, Hyeong-Seok Lee, Do-Yoon Lee, and Dong-Oh Lee. "The Efficacy of Carotid Tubercle as an Anatomical Landmark for Identification of Cervical Spinal Level in the Anterior Cervical Surgery: Comparison with Preoperative C-arm Fluoroscopy." Clinics in Orthopedic Surgery 5, no. 2 (2013): 129. http://dx.doi.org/10.4055/cios.2013.5.2.129.
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Karampouga, Maria, Liang Xa, Gregory J. Varga, et al. "The Transpterygoid-Transmandibular Strut-Transmedial Jugular Tubercle Inferior Transpetrosal Endoscopic Endonasal Approach as a Roadmap to the Parapharyngeal Internal Carotid Artery: Clinical Case Presentation and Operative Video." Journal of Neurological Surgery Part B: Skull Base 86, S 01 (2025): S1—S576. https://doi.org/10.1055/s-0045-1803491.
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Civelek, Erdinc, Talat Kiris, Kemal Hepgul, Ali Canbolat, Gokhan Ersoy, and Tufan Cansever. "Anterolateral approach to the cervical spine: major anatomical structures and landmarks." Journal of Neurosurgery: Spine 7, no. 6 (2007): 669–78. http://dx.doi.org/10.3171/spi-07/12/669.
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Object The authors undertook a study to explore the topographic anatomical features seen during the anterolateral approach to cervical spine, anatomical variations, and certain landmarks related to the surgical procedure. Methods The study was conducted in 30 fresh cadavers. Results The common carotid artery bifurcation was mostly found at the level of C-4 (78%). The inferior belly of the omohyoid muscle was seen to cross the sternocleidomastoid muscle at the C5–6 disc level along the entire C-6 vertebral body. To reach the lower cervical region, the sacrifice of this muscle makes the procedure easier. The facial vein drained into the internal jugular vein mostly at the level of C3–4 (54%). The superior ganglion of the cervical sympathetic chain was located at the C-4 vertebra, but the location of the intermediate ganglion exhibited some variation. The vertebral artery entered the transverse foramen of C-6 in 27 cadavers (90%), the transverse foramen of C-7 in two cadavers (7%), and the transverse foramen of C-4 in one cadaver (3%). Because the inferior thyroid artery crossed the C6–7 interspace obliquely, the course of the inferior thyroid artery may complicate the procedure. The C-5 uncinate process was shortest and narrowest and had the greatest distance from the medial edge of the process to the anterior tubercle (p < 0.001). Conclusions Understanding the qualitative anatomy of this region not only improves the safety of anterior and anterolateral cervical spine surgery but also allows adequate decompression of neural elements and resolution of the other pathological processes of this region. In this fresh cadaveric study, our goal was to improve the approach and decrease the incidence of complications.
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Wang, Wei-Hsin, Stefan Lieber, Roger Neves Mathias, et al. "The foramen lacerum: surgical anatomy and relevance for endoscopic endonasal approaches." Journal of Neurosurgery 131, no. 5 (2019): 1571–82. http://dx.doi.org/10.3171/2018.6.jns181117.
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OBJECTIVEThe foramen lacerum is a relevant skull base structure that has been neglected for many years. From the endoscopic endonasal perspective, the foramen lacerum is a key structure due to its location at the crossroad between the sagittal and coronal planes. The objective of this study was to provide a detailed investigation of the surgical anatomy of the foramen lacerum and its adjacent structures based on anatomical dissections and imaging studies, propose several relevant key surgical landmarks, and demonstrate the surgical technique for its full exposure with several illustrative cases.METHODSTen colored silicone-injected anatomical specimens were dissected using a transpterygoid approach to the foramen lacerum region in a stepwise manner. Five similar specimens were used for a comparative transcranial approach. The osseous anatomy was examined in 32 high-resolution multislice CT studies and 1 disarticulated skull. Representative cases were selected to illustrate the application of the findings.RESULTSThe pterygosphenoidal fissure is the synchondrosis between the lacerum process of the pterygoid bone and the floor of the sphenoid bone. It constantly converges with the posterior end of the vidian canal at a 45° angle, and its posterolateral end points directly to the lacerum foramen. The pterygoid tubercle separates the vidian canal from the pterygosphenoidal fissure, and forms the anterior wall of the lower part of the foramen lacerum. The lingual process, which forms the lateral wall of the foramen lacerum, was identified in 53 of 64 sides and featured an average height of 5 mm. The mandibular strut separates the foramen lacerum from the foramen ovale and had an average width of 5 mm.CONCLUSIONSThis study provides relevant surgical landmarks and a systematic approach to the foramen lacerum by defining anterior, medial, lateral, and inferior walls that may facilitate its safe exposure for effective removal of lesions while minimizing the risk of injury to the internal carotid artery.
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Wu, Kyle C., Emad Aboud, and Ossama Al-Mefty. "Suprabulbar Approach to Jugular Fossa Tumors: 2-Dimensional Operative Video." Operative Neurosurgery 21, no. 6 (2021): E524—E525. http://dx.doi.org/10.1093/ons/opab339.
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Abstract Owing to their scarcity, location, and intricate neurovascular associations, jugular fossa tumors are among the most challenging pathologies encountered by the neurosurgeon.1 While paragangliomas originate within and often occlude the jugular bulb, schwannomas and meningiomas are extra-bulbar and typically do not impede venous flow.2 Schwannomas typically arise from an extradural origin, expanding the jugular foramen.3-5 Meningiomas are intradural and cause hyperostosis of the jugular tubercle.6 We described and have been exposing and resecting jugular fossa tumors through a presigmoid suprabulbar infralabyrinthine window6 that has been detailed in cadaveric studies.7,8 This approach maintains the patency of the jugular bulb without breaching the labyrinths or manipulating the facial nerve. It is applicable to cases with partially impaired hearing and intact lower cranial nerves. The carotid artery can be identified by neuronavigation and micro-Doppler ultrasonography. This approach provides a direct lateral trajectory with a short distance to the jugular fossa and cerebellopontine angle. Early exposure and central debulking of the tumor minimize manipulation of the exquisitely sensitive lower cranial nerves. The distal aspect of these tumors can be removed with endoscopic assisted techniques.9 The first patient is a 49-yr-old woman with a previously irradiated schwannoma who presented with worsening neurologic deficits—an extradural suprabulbar approach was used to resect this tumor. The second patient is a 27-yr-old woman with an enlarging meningioma and associated neurological dysfunction; this tumor was resected using the suprabulbar approach with opening of the presigmoid dura. Both patients have consented to surgery and publication of images. Image at 2:27 and 6:38 reprinted from Arnautović et al, with permission from JNSPG. Image at 2:50 and 6:45 ©Ossama Al-Mefty 1997, reused with permission.
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Chanda, Amitabha, and Anil Nanda. "Retrosigmoid Intradural Suprameatal Approach: Advantages and Disadvantages from an Anatomical Perspective." Operative Neurosurgery 59, suppl_1 (2006): ONS—1—ONS—6. http://dx.doi.org/10.1227/01.neu.0000220673.79877.30.
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Abstract OBJECTIVE: To assess the advantages and disadvantages of the retrosigmoid intradural suprameatal approach by studying the microsurgical anatomy. This study was performed primarily to assess the advantages of the retrosigmoid intradural suprameatal approach by measuring the amount of increased exposure it provides for lesions of the cerebellopontine and petroclival region as well as to identify the disadvantages of the approach. METHODS: Twenty sides of 10 cadaver heads (embalmed and injected) were dissected under ×3 to ×40 magnification. A standard retrosigmoid craniotomy was made. The cerebellopontine cistern was entered to expose the neurovascular structures, and the internal auditory canal was opened by drilling the margin of the internal auditory meatus. After this, the suprameatal tubercle was drilled, followed by additional drilling to resect the petrous apex. The trigeminal root was mobilized completely after opening Meckel's cave. During drilling, care was taken to preserve the posterior and superior semicircular canals, petrosal sinus, and the internal carotid artery. RESULTS: The approach enhanced the exposure of the cerebellopontine cistern and Meckel's cave. There was an additional exposure of 10.7 ± 1.16 mm length of trigeminal nerve on the right side and an additional 10.7 ± 1.25 mm on the left. This helped to mobilize and further retract the trigeminal root. Although it facilitated the view of the neurovascular structures medial to the internal acoustic meatus, the depth of exposure did not vary much from a traditional retrosigmoid approach nor did it increase the angle of exposure or the visualization of the clivus and more medially located structures. CONCLUSION: This approach is suitable for lesions mainly in the posterior fossa with some extension into the middle fossa in the anterolateral direction. The key benefits of this approach are the length of trigeminal nerve exposure and the subsequent mobilization that improves visualization of the structures medial to the internal auditory canal, to the petrous apex, Meckel's cave, and the posterior end of the cavernous sinus.
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Tubbs, R. Shane, E. George Salter, James W. Custis, John C. Wellons, Jeffrey P. Blount, and W. Jerry Oakes. "Surgical anatomy of the cervical and infraclavicular parts of the long thoracic nerve." Journal of Neurosurgery 104, no. 5 (2006): 792–95. http://dx.doi.org/10.3171/jns.2006.104.5.792.
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Object There is insufficient information in the neurosurgical literature regarding the long thoracic nerve (LTN). Many neurosurgical procedures necessitate a thorough understanding of this nerve's anatomy, for example, brachial plexus exploration/repair, passes for ventriculoperitoneal shunt placement, pleural placement of a ventriculopleural shunt, and scalenotomy. In the present study the authors seek to elucidate further the surgical anatomy of this structure. Methods Eighteen cadaveric sides were dissected of the LTN, anatomical relationships were observed, and measurements were obtained between it and surrounding osseous landmarks. The LTN had a mean length of 27 ± 4.5 cm (mean ± standard deviation) and a mean diameter of 3 ± 2.5 mm. The distance from the angle of the mandible to the most proximal portion of the LTN was a mean of 6 ± 1.1 cm. The distance from this proximal portion of the LTN to the carotid tubercle was a mean of 3.3 ± 2 cm. The LTN was located a mean 2.8 cm posterior to the clavicle. In 61% of all sides the C-7 component of the LTN joined the C-5 and C-6 components of the LTN at the level of the second rib posterior to the axillary artery. In one right-sided specimen the C-5 component directly innervated the upper two digitations of the serratus anterior muscle rather than joining the C-6 and C-7 parts of this nerve. The LTN traveled posterior to the axillary vessels and trunks of the brachial plexus in all specimens. It lay between the middle and posterior scalene muscles in 56% of sides. In 11% of sides the C-5 and C-6 components of the LTN traveled through the middle scalene muscle and then combined with the C-7 contribution. In two sides, all contributions to the LTN were situated between the middle scalene muscle and brachial plexus and thus did not travel through any muscle. The C-7 contribution to the LTN was always located anterior to the middle scalene muscle. In all specimens the LTN was found within the axillary sheath superior to the clavicle. Distally, the LTN lay a mean of 15 ± 3.4 cm lateral to the jugular notch and a mean of 22 ± 4.2 cm lateral to the xiphoid process of the sternum. Conclusions The neurosurgeon should have knowledge of the topography of the LTN. The results of the present study will allow the surgeon to better localize this structure superior and inferior to the clavicle and decrease morbidity following invasive procedures.
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Siribumrungwong, Koopong, Chitpon Sinchai, Boonsin Tangtrakulwanich, and Weera Chaiyamongkol. "Reliability and Accuracy of Palpable Anterior Neck Landmarks for the Identification of Cervical Spinal Levels." Asian Spine Journal 12, no. 1 (2018): 80–84. http://dx.doi.org/10.4184/asj.2018.12.1.80.
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<sec><title>Study Design</title><p>A descriptive experimental study.</p></sec><sec><title>Purpose</title><p>The purpose of this study was to describe the reliability and accuracy of palpable anterior neck landmarks (angle of the mandible, hyoid bone, thyroid cartilage, and cricoid cartilage) for the identification of cervical spinal levels in a slight neck-extended position as in anterior approach cervical spinal surgery.</p></sec><sec><title>Overview of Literature</title><p>Standard, palpable anatomical landmarks for the identification of cervical spinal levels were described by Hoppenfeld using the midline palpable anterior structures (angle of the mandible [C2 body], hyoid bone [C3 body], thyroid cartilage [C4–C5 disc], cricoid cartilage [C6 body], and carotid tubercle [C6 body]) to determine the approximate level for skin incisions. However, in clinical practice, patients are positioned with a slight neck extension to achieve cervical lordosis. This positioning (neck extension) may result in changes in the locations of anatomical landmarks compared with those reported in previous studies.</p></sec><sec><title>Methods</title><p>This experimental study was conducted on 96 volunteers. Each volunteer was palpated for locating four anatomical landmarks three times by three different orthopedic surgeons. We collected data from the level of the vertebral body or the vertebral disc matching the surface anatomical landmarks from the vertical reference line.</p></sec><sec><title>Results</title><p>Accuracy of the angle of the mandible located at the C2 vertebral body was 95.5%, the hyoid bone located at the C2/3 intervertebral disc was 51.7%, the thyroid cartilage located at the C4 vertebral body was 42%, and the cricoid cartilage located at the C5/6 intervertebral disc was 43.4%.</p></sec><sec><title>Conclusions</title><p>With the neck in a slightly extended position to achieve cervical lordosis, the angle of the mandible, the hyoid bone, the thyroid cartilage, and the cricoid cartilage were most often located at the C2 body, the C2/3 disc, the C4 body, and the C5/6 disc, respectively. The angle of the mandible and the hyoid bone are highly reliable surface anatomical landmarks for the identification of cervical spinal levels than the thyroid cartilage and the cricoid cartilage.</p></sec>
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Calotă, Rodica Narcisa, Mugurel Constantin Rusu, Cătălin Constantin Dumitru, Liliana Moraru, and Răzvan Costin Tudose. "Retropharyngeal course of the superior thyroid artery – a novel finding." Surgical and Radiologic Anatomy 47, no. 1 (2025). https://doi.org/10.1007/s00276-025-03627-7.
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Abstract Purpose The anatomical variables of the superior thyroid artery (STA) are well-studied. It typically leaves the external carotid artery (ECA) and descends on the inferior pharyngeal constrictor muscle to reach the thyroid lobe. We serendipitously found a novel possibility: the bilateral retropharyngeal course of the STA, which we report here. Method The case was found while studying the archived angioCT file of a 56-year-old male. Results The right carotid bifurcation (CB) was in the coronal plane at 3.3 mm inferior to the greater horn of the hyoid bone (GHHB). The initial segment of the ECA was medial to the GHHB. The origin of the right STA was at 2.7 cm medial to the GHHB greater hyoid horn from the anterior side of the ECA. The left CB was at 2.5 mm posterior to the left hyoid tubercle. It was oriented sagittally oblique, with the left ECA antero-medially to the left ICA. The left STA arose from the medial side of the ECA at 5.6 mm postero-superior to the hyoid tubercle. Each STA descended medially to the GHHB and, further, the superior horn of the thyroid cartilage on that side. At the root of the superior horn of the thyroid cartilage, each STA turned laterally between the common carotid artery and the posterior margin of the lamina of the thyroid cartilage and continued to the thyroid lobe on that side. Thus, both STAs coursed posteriorly to the pyriform recess of the hypopharynx on that side. Conclusion Finding bilateral STAs is extraordinary but possible. Such extremely rare variants can be accurately identified during preoperative angioCT scans.
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Tasleem, Maria, Mohtasham Hina, Fauzia Qureshi, Imtiaz Aslam, Iram Atta, and Raafea Tafweez. "Prevalence And Morphometric Analysis Of Fossa Navicularis Magna In Dry Human Skulls." Journal of Rawalpindi Medical College 27, no. 2 (2023). http://dx.doi.org/10.37939/jrmc.v27i2.2208.
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Introduction: Basiocciput is the part of occipital bone present on the inferior aspect of skull. Fossa Navicularis Magna-an osseous defect is a variation in normal anatomy of basiocciput. Lately few case reports presented this fossa as a cause of spread of infection from nasopharynx to brain resulting in meningitis and osteomyelitis.
 Objectives: This study aims to find the incidence and morphometry of this fossa in Pakistani populace to avoid any misdiagnosis or misinterpretations.
 Materials & Methods: This study was conducted on dry human skulls at King Edward Medical University Lahore. Fossa was measured in its transverse and vertical diameters and to locate the fossa its distance from various anatomical land marks such as foramen ovale, foramen Lacerum, carotid canal, occipital condyles, pharyngeal tubercle and posterior border of vomer was noted.
 Results: The incidence of this fossa was found to be 5.3% in Pakistani population. Predominantly oval shaped, fossa measured 5.5 and 3.06 mm in vertical and transverse diameters respectively. It was 12.2 mm posterior to vomer and 5.9 mm anterior to pharyngeal tubercle.
 Conclusion: This study is useful for radiologists and clinicians in avoiding any misinterpretations on radiographs and unnecessary investigations
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Fayed, Ashraf, Mohamed E. El-Deeb, Jacques Magnan, Renaud Meller, Arnaud Deveze, and Saad Elzayat. "Lower Four Cranial Nerves in the Management of Glomus Jugulare: Anatomical Study." International Archives of Otorhinolaryngology, April 11, 2023. http://dx.doi.org/10.1055/s-0042-1755308.
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Abstract Introduction The surgical management that achieves minimal morbidity and mortality for patients with glomus and non-glomus tumors involving the jugular foramen (JF) region requires a comprehensive understanding of the complex anatomy, anatomic variability, and pathological anatomy of this region. Objective The aim of this study is to propose a rational guideline to expose and preserve the lower cranial nerves (CNs) in the lateral approach of the JF. Methods The technique utilized is the gross and microdissection of 4 fixed cadaveric heads to revise the JF's surgical anatomy and high part of the carotid sheath compared with surgical cases to understand and preserve the integrity of lower CNs. The method involves radical mastoidectomy, microdissection of the JF, facial nerve, and high neck just below the carotid canal and the JF. The CNs IX, X, XI, and XII are microscopically dissected and kept in sight up to the JF. Results This study realized well the surgical and applied anatomy of the lower CNs with relation to the facial nerve and JF. Conclusions The JF anatomy is complicated, and the key to safely operate on it and preserving the lower CNs is to find the posterior belly of the digastric muscle, to skeletonize the facial nerve, to remove the mastoid tip preserving the stylomastoid foramen, to skeletonize the sigmoid sinus and posterior fossa dura not only anterior but also posteroinferior to reach and drill the jugular tubercle.
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Klimenko, D. I., K. A. Krasnov, D. A. Evteeva, et al. "The effects of 1-methyl-4-(4-fluorophenyl)- 1,2,3,6-tetrahydropyridine on biochemical parameters of blood serum and monoamine metabolism in the brain of mice." Laboratornye Zhivotnye dlya nauchnych issledovanii (Laboratory Animals for Science) 6, no. 4 (2023). http://dx.doi.org/10.57034/2618723x-2023-04-07.
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Changes in biochemical parameters of blood serum and monoamine metabolism in the brain were studied on male white outbred mice subjected to intraperitoneal injections of 1-methyl-4-(4-fluorophenyl)-1,2,3,6-tetrahydropyridine (MPTP-F). The levels of norepinephrine, dopamine, serotonin and their metabolites — dioxyphenylacetic, homovanilinic and 5-hydroxyindolacetic acids — were neasured by HPLC in the cerebral cortex, hippocampus, olfactory tubercle and striatum of the right and left sides of the brain. The treatement with MPTP-F did not lead to significant changes in the biochemical parameters of blood serum. An increase in the norepinephrine concentration a decrease in the dopamine level in the right striatum were found in animals treated with MPTP-F. No changes were detected in other studied brain areas. It has been suggested that the effect of the neurotoxin MPTP-F is determined by several factors, i. e. the lipophilic properties of the molecule, the quantitative distribution of dopamine neurons between right and left sides of the brain, differences in the linear velocity of blood flow through the right and left carotid arteries and the state of the blood-brain barrier. The results obtained may indicate the prospects of using MPTP-F for modeling the early stage of Parkinson’s disease.
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Ali, M. Salman, Hanna Algattas, Georgios A. Zenonos, Eric W. Wang, Carl H. Snyderman, and Paul A. Gardner. "Endoscopic Endonasal Far-Medial Approach: 2-Dimensional Operative Video." Operative Neurosurgery, November 2, 2023. http://dx.doi.org/10.1227/ons.0000000000000970.
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INDICATIONS: CORRIDOR AND LIMITS OF EXPOSURE: Endoscopic endonasal far-medial approach provides an effective and safe corridor to access the parasagittal structures of the lower clivus such as the medial jugular tubercle (JT) and occipital condyle (OC) for lesions that displace neurovascular structures laterally. ANATOMIC ESSENTIALS: NEED FOR PREOPERATIVE PLANNING AND ASSESSMENT: Parapharyngeal internal carotid arteries (ICAs) run posterolateral to the eustachian tubes and lateral to the OC. The supracondylar groove is a superficial landmark for the hypoglossal canal, which divides the lateral extension of clivus into the JT and OC. ESSENTIAL STEPS OF THE PROCEDURE: Typically, approach starts with opening of the sphenoid sinus to localize the paraclival ICA. An “inverted U” rhinopharyngeal (RP) flap exposing the supracondylar groove and lower clivus. Doppler and navigation can confirm the course of the ICA. Drilling is started in the midline in the lower clivus and extended laterally to expose the hypoglossal canal, JT, and OC. PITFALLS/AVOIDANCE OF COMPLICATIONS: Neurovascular injuries can be avoided by using intraoperative Doppler and nerve stimulator. Multilayer reconstruction with vascularized nasoseptal (NSF) and RP flaps minimize postoperative cerebrospinal fluid leak. VARIANTS AND INDICATIONS FOR THEIR USE: The contralateral transmaxillary approach provides an increased angle of access behind foramen lacerum and the petrous ICA. The endoscopic endonasal far-medial approach can be used for a variety of pathologies, including petroclival or JT meningiomas, chordomas and chondrosarcomas, and hypoglossal schwannomas, inferiorly extending cholesterol granulomas and even rare, ventral posterior inferior cerebellar artery aneurysms. The patients consented to the procedure.
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Fargen, Kyle M., Jackson P. Midtlien, Katherine Belanger, Edward J. Hepworth, and Ferdinand K. Hui. "The Promise, Mystery, and Perils of Stenting for Symptomatic Internal Jugular Vein Stenosis: A Case Series." Neurosurgery, March 13, 2024. http://dx.doi.org/10.1227/neu.0000000000002891.
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BACKGROUND AND OBJECTIVES: Cerebral venous outflow disorders (CVDs) secondary to internal jugular vein (IJV) stenosis are becoming an increasingly recognized cause of significant cognitive and functional impairment in patients. There are little published data on IJV stenting for this condition. This study aims to report on procedural success. METHODS: A single-center retrospective analysis was performed on patients with CVD that underwent IJV stenting procedures. RESULTS: From 2019 to 2023, 29 patients with CVD underwent a total of 33 IJV stenting procedures. Most patients (20; 69%) had an underlying connective tissue disorder diagnosis. The mean age of the included patients was 36.3 years (SD 12.4), 24 were female (82.8%), and all were Caucasian except for 2 patients (27; 93.0%). Twenty-eight procedures (85%) involved isolated IJV stenting under conscious sedation, whereas 5 procedures (15%) involved IJV stenting and concomitant transverse sinus stenting under general anesthesia. Thirteen (39%) patients underwent IJV stenting after open IJV decompression and styloidectomy. Three patients had stents placed for stenosis below the C1 tubercle, one of which was for carotid compression. Periprocedural complications occurred in 11 (33%), including intracardiac stent migration in 1 patient, temporary shoulder pain/weakness in 5 (15%), and persistent and severe shoulder pain/weakness in 2 patients (6%). Approximately 75% of patients demonstrated improvement after stenting although only 12 patients (36%) had durable improvement over a mean follow-up of 4.5 months (range 6 weeks-3.5 years). CONCLUSION: Our experience, along with early published studies, suggests that there is significant promise to IJV revascularization techniques in these patients; however, stenting carries a high complication rate, and symptom recurrence is common. Most neurointerventionalists should not be performing IJV stenting unless they have experience with these patients and understand technical nuances (stent sizing, anatomy, patient selection), which can maximize benefit and minimize risk.
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Liu, Jianfeng, Carlos D. Pinheiro-Neto, Dazhang Yang, et al. "Comparison of Endoscopic Endonasal Approach and Lateral Microsurgical Infratemporal Fossa Approach to the Jugular Foramen: An Anatomical Study." Journal of Neurological Surgery Part B: Skull Base, July 5, 2021. http://dx.doi.org/10.1055/s-0041-1731034.
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Abstract Objective The jugular foramen is one of the most challenging surgical regions in skull base surgery. With the development of endoscopic techniques, the endoscopic endonasal approach (EEA) has been undertaken to treat some lesions in this area independently or combined with open approaches. The purpose of the current study is to describe the anatomical steps and landmarks for the EEA to the jugular foramen and to compare it with the degree of exposure obtained with the lateral infratemporal fossa approach. Materials and Methods A total of 15 osseous structures related to the jugular foramen were measured in 33 adult dry skulls. Three silicone-injected adult cadaveric heads (six sides) were dissected for EEA and three heads (six sides) were used for a lateral infratemporal fossa approach (Fisch type A). The jugular foramen was exposed, relevant landmarks were demonstrated, and the distances between relevant landmarks and the jugular foramen were obtained. High-quality pictures were obtained. Results The jugular foramen was accessed in all dissections by using either approach. Important anatomical landmarks for EEA include internal carotid artery (ICA), petroclival fissure, inferior petrosal sinus, jugular tubercle, and hypoglossal canal. The EEA exposed the anterior and medial parts of the jugular foramen, while the lateral infratemporal fossa approach (Fisch type A) exposed the lateral and posterior parts of the jugular foramen. With EEA, dissection and transposition of the facial nerve was avoided, but the upper parapharyngeal and paraclival ICA may need to be mobilized to adequately expose the jugular foramen. Conclusion The EEA to the jugular foramen is anatomically feasible but requires mobilization of the ICA to provide access to the anterior and medial aspects of the jugular foramen. The lateral infratemporal approach requires facial nerve transposition to provide access to the lateral and posterior parts of the jugular foramen. A deep understanding of the complex anatomy of this region is paramount for safe and effective surgery of the jugular foramen. Both techniques may be complementary considering the different regions of the jugular foramen accessed with each approach.
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Mancini, Nastasia, Pasquale Crea, Giuseppe Dattilo, et al. "892 ELECTRICAL STORM IN ISCHAEMIC HEART DISEASE: A CASE OF LEFT STELLATE GANGLION BLOCK AS BRIDGE TO URGENT PCI RESCUE." European Heart Journal Supplements 24, Supplement_K (2022). http://dx.doi.org/10.1093/eurheartjsupp/suac121.054.
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Abstract A 73 year-old man was admitted for syncope and sustained ventricular arrhythmia complicated by cardiogenic shock treated with electrical cardioversion and restoration of sinus rhythm. Former smoker, he suffered by arterial hypertension, hypercholesterolemia and known heart failure with reduced ejection fraction. In the 1995 the patient underwent aortic valve replacement surgery with a mechanical prosthetic valve. The patient underwent coronary angiography that showed multivessel coronary artery disease with functional occlusion of posterior interventricular artery (rehabilitated by hetero-coronary circles) and critical stenosis of the middle left anterior descending artery. In this angiographic framework, the indication was collegial revaluation considering other patient's comorbidities (chronic renal dysfunction, mitral moderate-severe regurgitation). The patient underwent ICD implantation for secondary prevention. Despite maximal medical therapy, the patient experienced new episodes of sustained VT complicated by hemodynamic instability. Hypokalemia, hypomagnesemia and hyperthyroidism were excluded as triggering factors for arrhythmias on laboratory investigations. In the following days due to persistent and symptomatic arrhythmias, configuring electrical storm, we decided to proceed with anatomical stellate ganglion block, guarantying a free interval from ventricular arrhythmia about six hours. The anesthetic has been injected at the C6 or C7 vertebral level with the Chassignac's tubercle, the cricoid cartilage, and the carotid artery serving as the anatomic landmarks to the procedure. An aspiration test must be done to avoid the suction of blood or cerebrospinal fluid, then a local anesthetic is injected, and the diffusion of the injectate is seen in real-time. Local anesthetic (lidocaine mixed with bupivacaine) is injected until the fluid spread along the paravertebral fascia to the stellate ganglion. The period free from VA allowed us to transfer the patient in another center in order to receive myocardial revascularization supported by ECMO. Left ganglion stellate block has a central role in the treatment of the refractory ventricular arrhythmias and may offer effective arrhythmia control giving time to rescue and/or other bridge therapy. In our case, it had a key role to perform an inter-hospital transfer and subsequent “rescue PCI therapy”. Thanks to Stellate ganglion block, the sinus rhythm was retained immediately, there were no ventricular tachycardia episodes for at least six hours allowing to perform myocardial revascularization supported by ECMO. No further ventricular arrhythmias occurred after revascularization, corroborating the ischemic trigger of electrical storm.