Surgical anatomy of the carotid sympathetic plexus in endoscopic endonasal approaches: strategies for preventing Horner syndrome

Endoscopic endonasal approaches (EEAs) specifically for procedures involving manipulation of the internal carotid artery (ICA), such as the transcavernous and translacerum approaches, confer a potential risk of carotid sympathetic plexus injury, potentially leading to postganglionic Horner syndrome. The primary aim of this study was to delineate the surgical anatomy of the carotid sympathetic plexus from an endoscopic endonasal perspective, offering insights to facilitate intraoperative anatomical identification and injury prevention.