A cadaveric study and small clinical series evaluating direct endoscopic endonasal ligation of the internal carotid artery.

Kim, Cho, Kim, Kim, Han, Won and colleagues performed dissections in three cadaveric heads (six sides) to define a safe corridor for circumferential exposure and ligation of the internal carotid artery through an endonasal approach.

The authors identified the lower paraclival ICA, caudal to its entry into the cavernous sinus, as the most favorable segment for direct control. They also describe a fibrous structure termed the meningo-lingual band, whose division facilitates carotid mobilization.

The technique was subsequently applied in five selected clinical cases, with no reported stroke, new neurological deficit or major procedure-related complication.

Why it matters

This work is highly relevant for advanced endoscopic skull-base surgery because it provides a detailed anatomical strategy for direct carotid control in selected complex cases. The clinical experience remains very limited, so the technique should be considered complementary to established endovascular strategies rather than a routine alternative.

Reference

Kim D, Cho SW, Kim DY, Kim HJ, Han DH, Won TB, et al.
Endoscopic Endonasal Ligation of the Internal Carotid Artery: A Cadaveric Study and Case Series.
World Neurosurgery. Published October 9, 2026.
DOI: 10.1016/j.wneu.2026.125409
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