How I do it: parasellar internal carotid artery exposure in endoscopic endonasal surgery

Exposure of the parasellar internal carotid artery (ICA) represents one of the most critical and high-risk steps of endoscopic endonasal skull base surgery. However, detailed technical descriptions of controlled ICA skeletonization remain limited. We present a stepwise demonstration of parasellar ICA exposure through an illustrative surgical video complemented by cadaveric dissections. A controlled “brush” technique using a diamond burr is described, based on tangential movements and progressive egg-shell thinning of the overlying bone. This reproducible technical framework aims to improve drilling precision, enhance surgeon control, and reduce the risk of vascular injury during parasellar ICA exposure.