Carotid cave

The carotid cave is a potential dural space formed by the redundant distal dural ring on the medial aspect of clinoid segment of internal carotid artery (ICA). It has been reported to be present in ~80% of cadaveric specimens 3.

The ICA's clinoid segment is bounded by proximal and distal dural rings that are variably adherent to each other on the anterior aspect. The distal dural ring is inclined posteromedially, tightly adherent to the lateral aspect of ICA but loosely adherent to the medial aspect, creating a potential space, the carotid cave.

The clinical significance of this region lies in the fact that aneurysms projecting medially from the ICA in this location (commonly referred to as carotid cave aneurysms) may be entirely extradural or may have an intradural component.  If entirely extradural in location, rupture does not produce subarachnoid haemorrhage. On the other hand if partially intradural (typically the base) then subarachnoid haemorrhage is a possibility, and thus treatment potentially required.

On imaging (CT, MRI, DSA) the relationship of the aneurysm to the distal dual ring can be difficult to establish, although occasionally a waist or indentation may be visible, and as such treatment or surgical exploration may be required. These are called transitional aneurysms, with potential for SAH.


Neuroanatomy
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Article Information

rID: 26010
Section: Anatomy
Tags: stub, cases, refs
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