Histology of the distal dural ring

Christopher S. Graffeo, Avital Perry, William R. Copeland, Aditya Raghunathan, Michael J. Link

Research output: Contribution to journalArticle

Abstract

The distal dural ring (DDR) is a conserved intracranial anatomic structure marking the boundary point at which the internal carotid artery (ICA) exits the cavernous sinus (CS) and enters the subarachnoid space. Although the CS has been well described in a range of anatomic studies, to our knowledge no prior study has analyzed the histologic relationship between the ICA and DDR. Correspondingly, our objective was to assess the relationship of the DDR to the ICA and determine whether the DDR can be dissected from the ICA and thus divided, or can only be circumferentially trimmed around the artery. The authors examined ten fresh-frozen, adult cadaveric specimens. A standard frontotemporal craniotomy, orbito-optic osteotomy, and extradural anterior clinoidectomy was performed bilaterally. The cavernous ICA, DDR, and supraclinoid ICA were harvested as an en bloc specimen. Specimens formalin-fixed and paraffin-embedded prior to routine histochemical staining with hematoxylin and eosin and Masson trichrome. In all specimens, marked microscopic investment of the DDR throughout the ICA adventitia was noted. Dural collagen fibers extensively permeated the arterial layers superficial to the muscularis propria, with no evidence of a clear separation between the DDR and arterial adventitia. Histologic analysis suggests that the ICA and DDR are highly interrelated, continuous structures, and therefore attempted intraoperative dissection between these structures may carry an elevated risk of injury to the ICA. We correspondingly recommend careful circumferential trimming of the DDR in lieu of direct dissection in cases requiring mobilization of the clinoidal ICA.

Original languageEnglish (US)
JournalClinical Anatomy
DOIs
StateAccepted/In press - 2017

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Internal Carotid Artery
Histology
Adventitia
Cavernous Sinus
Dissection
Subarachnoid Space
Craniotomy
Hematoxylin
Eosine Yellowish-(YS)
Osteotomy
Paraffin
Formaldehyde
Collagen
Arteries
Staining and Labeling
Wounds and Injuries

Keywords

  • Cavernous sinus
  • Intracranial aneurysm
  • Meninges
  • Microdissection
  • Microsurgery
  • Neuroanatomy
  • Neurosurgery

ASJC Scopus subject areas

  • Anatomy
  • Histology

Cite this

Graffeo, C. S., Perry, A., Copeland, W. R., Raghunathan, A., & Link, M. J. (Accepted/In press). Histology of the distal dural ring. Clinical Anatomy. https://doi.org/10.1002/ca.22916

Histology of the distal dural ring. / Graffeo, Christopher S.; Perry, Avital; Copeland, William R.; Raghunathan, Aditya; Link, Michael J.

In: Clinical Anatomy, 2017.

Research output: Contribution to journalArticle

Graffeo, Christopher S. ; Perry, Avital ; Copeland, William R. ; Raghunathan, Aditya ; Link, Michael J. / Histology of the distal dural ring. In: Clinical Anatomy. 2017.
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