The internal carotid artery is an artery in the neck which supplies the anterior and middle cerebral circulation. In human anatomy, the internal and external carotid arise from the common carotid artery, where it bifurcates at cervical vertebrae C3 or C4. The internal carotid artery supplies the brain, including the eyes, while the external carotid nourishes other portions of the head, such as the face, scalp, skull, and meninges.
Classification Terminologia Anatomica in 1998 subdivided the artery into four parts: "cervical", "petrous", "cavernous", and "cerebral". In clinical settings, however, usually the classification system of the internal carotid artery follows the 1996 recommendations by Bouthillier, describing seven anatomical segments of the internal carotid artery, each with a corresponding alphanumeric identifier: C1 cervical; C2 petrous; C3 lacerum; C4 cavernous; C5 clinoid; C6 ophthalmic; and C7 communicating. The Bouthillier nomenclature remains in widespread use by neurosurgeons, neuroradiologists and neurologists. The segments are subdivided based on anatomical and microsurgical landmarks and surrounding anatomy, more than angiographic appearance of the artery. An alternative embryologic classification system proposed by Pierre Lasjaunias and colleagues is invaluable when it comes to explanation of many internal carotid artery variants. An older clinical classification, based on pioneering work by Fischer, is mainly of historical significance.
The segments of the internal carotid artery are as follows:
Cervical segment, or C1, identical to the commonly used cervical portion Petrous segment, or C2 Lacerum segment, or C3 C2 and C3 compose the commonly termed petrous portion Cavernous segment, or C4, almost identical to the commonly used cavernous portion Clinoid segment, or C5. This segment is not identified in some earlier classifications and lies between the commonly used cavernous portion and cerebral or supraclinoid portion. Ophthalmic, or supraclinoid segment, or C6 Communicating, or terminal segment, or C7 C6 and C7 together constitute the commonly used cerebral or supraclinoid portion.
Course/part
The internal carotid artery is a terminal branch of the common carotid artery; it arises around the level of the fourth cervical vertebra when the common carotid bifurcates into this artery and its more superficial counterpart, the external carotid artery.
C1: Cervical segment
The cervical segment, or C1, or cervical part of the internal carotid, extends from the carotid bifurcation until it enters the carotid canal in the skull anterior to the jugular foramen.
At its origin, the internal carotid artery is somewhat dilated. This part of the artery is known as the carotid sinus or the carotid bulb. The ascending portion of the cervical segment occurs distal to the bulb when the vessel walls are again parallel. The internal carotid runs vertically upward in the carotid sheath and enters the skull through the carotid canal. During this part of its course, it lies in front of the transverse processes of the upper three cervical vertebrae. It is relatively superficial at its start, where it is contained in the carotid triangle of the neck, and lies behind and medial to the external carotid, overlapped by the sternocleidomastoid muscle, and covered by the deep fascia, the platysma, and integument: it then passes beneath the parotid gland, being crossed by the hypoglossal nerve, the digastric muscle and the stylohyoid muscle, the occipital artery and the posterior auricular artery. Higher up, it is separated from the external carotid by the styloglossus and stylopharyngeus muscles, the tip of the styloid process and the stylohyoid ligament, the glossopharyngeal nerve and the pharyngeal branch of the vagus nerve. It is in relation, behind, with the longus capitis, the superior cervical ganglion of the sympathetic trunk, and the superior laryngeal nerve; laterally, with the internal jugular vein and vagus nerve, the nerve lying on a plane posterior to the artery; medially, with the pharynx, superior laryngeal nerve, and ascending pharyngeal artery. At the base of the skull the glossopharyngeal, vagus, accessory, and hypoglossal nerves lie between the artery and the internal jugular vein. Unlike the external carotid artery, the internal carotid normally has no branches in the neck.
C2: Petrous segment The petrous segment, or C2, of the internal carotid, is that which is inside the petrous part of the temporal bone. This segment extends until the foramen lacerum. The petrous portion classically has three sections:
an ascending, or vertical, portion; the genu, or bend; and the horizontal portion. When the internal carotid artery enters the canal in the petrous portion of the temporal bone, it first ascends a short distance and then curves anteriorly and medially. The artery lies at first in front of the cochlea and tympanic cavity; from the latter cavity it is separated by a thin, bony lamella, which is cribriform in the young subject, and often partly absorbed in old age. Farther forward, it is separated from the trigeminal ganglion by a thin plate of bone, which forms the floor of the fossa for the ganglion and the roof of the horizontal portion of the canal. Frequently this bony plate is more or less deficient, and then the ganglion is separated from the artery by fibrous membrane. The artery is separated from the bony wall of the carotid canal by a prolongation of dura mater and is surrounded by a number of small veins and by filaments of the carotid plexus, derived from the ascending branch of the superior cervical ganglion of the sympathetic trunk. The named branches of the petrous segment of the internal carotid artery are:
the vidian artery or artery of the pterygoid canal the caroticotympanic artery
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