Morphological Analysis of the Cavernous Segment of the Internal Carotid Artery: A Retrospective, Single Center Study of Its Clinical Significance

Background/Objectives: The cavernous segment of the internal carotid artery (ICA) is a critical neurovascular structure with complex cranial nerve relationships. Understanding its morphometric variability is essential for safe microsurgical and endovascular procedures. This study aimed to characterize the morphometry of the cavernous ICA using Magnetic resonance imaging (MRI) and assess associations with demographic variables. Methods: A retrospective observational study was conducted on 135 MRI scans of adult patients, distributed among 79 women and 56 men with an average age of 50.8 years, without cerebrovascular pathology, performed between March 2023 and January 2025. The diameters of the left and right cavernous ICA and the intercarotid distance were measured using RadiAnt DICOM Viewer. Statistical analyses included descriptive statistics, t-tests, correlations, and multivariate regression models adjusted for age and sex. Principal component and cluster analyses were applied to identify morphometric patterns. Results: The mean left and right ICA diameters were both 5.09 ± 0.65 mm, with a mean intercarotid distance of 17.4 ± 4.22 mm. No age-related associations were found (p > 0.05). Male patients showed significantly larger right ICA diameters (p = 0.008). Bilateral symmetry was confirmed (p > 0.05). Two morphometric clusters were identified: Morphotype 1 (larger ICA caliber and narrower spacing) and Morphotype 2 (smaller caliber and wider spacing), showing a significant sex distribution difference (p = 0.012). Conclusions: The cavernous ICA demonstrates stable bilateral symmetry with minor sex-dependent differences. Morphometric characterization supports safer planning of transsphenoidal, endovascular, and skull-base surgeries by reducing the risk of iatrogenic neurovascular injury.