Quantitative Analysis of Variable Extent of Anterior Clinoidectomy With Intradural and Extradural Approaches (original) (raw)
Related papers
Neurosurgery, 2015
Drilling of the anterior clinoid process (ACP) is an integral component of surgical approaches for central and paracentral skull base lesions. The technique to drill ACP has evolved from pure intradural to extradural and combined techniques. To describe the computerized morphometric evaluation of exposure of optic nerve and internal carotid artery with proposed tailored intradural (IDAC) and complete extradural (EDAC) anterior clinoidectomy. We describe a morphometric subdivision of ACP into 4 quadrangles and 1 triangle on the basis of fixed bony landmarks. Computerized volumetric analysis with 3-dimensional laser scanning of dry-drilled bones for respective tailored IDAC and EDAC was performed. Both approaches were compared for the area and length of the optic nerve and internal carotid artery. Five cadaver heads were dissected on alternate sides with intradural and extradural techniques to evaluate exposure, surgical freedom, and angulation of approach. Complete anterior clinoidec...
Anterior clinoidectomy using an extradural and intradural 2-step hybrid technique
Journal of neurosurgery, 2018
Anterior clinoidectomy is a difficult yet essential technique in skull base surgery. Two main techniques (extradural and intradural) with multiple modifications have been proposed to increase efficiency and avoid complications. In this study, the authors sought to develop a hybrid technique based on localization of the optic strut (OS) to combine the advantages and avoid the disadvantages of both techniques. Ten cadaveric specimens were prepared for surgical simulation. After a standard pterional craniotomy, the anterior clinoid process (ACP) was resected in 2 steps. The segment anterior to the OS was resected extradurally, while the segment posterior to the OS was resected intradurally. The proposed technique was performed in 6 clinical cases to evaluate its safety and efficiency. Anterior clinoidectomy was successfully performed in all cadaveric specimens and all 6 patients by using the proposed technique. The extradural phase enabled early decompression of the optic nerve while a...
Extradural anterior clinoidectomy: Technical nuances from a learner′s perspective
Asian Journal of Neurosurgery, 2014
been debated upon. Extradural anterior clinoidectomy is often perceived as difficult and risky due to the constricted working space and the vulnerability of critical anatomical structures encountered, which includes the clinoidal carotid segment, oculomotor nerve and the optic nerve. However, with proper extradural exposure of the ACP and accurate knowledge of the anatomical relationships in this region, extradural anterior clinoidectomy can be safely accomplished. Illustrating through cadaveric prosection, we intend to describe in this paper the proper technique for extradural clinoidectomy, emphasizing the key steps for optimum exposure and safe removal of the anterior clinoid.
Selective extradural anterior clinoidectomy for supra- and parasellar processes
Journal of Neurosurgery, 1997
✓ Removal of the anterior clinoid process (ACP) facilitates radical removal of tumors or radical neck clipping of aneurysms in the supra- and parasellar regions by providing a wide operative exposure of the internal carotid artery (ICA) and the optic nerve and by reducing the need for brain retraction. Over a period of 3 years, anterior clinoidectomy was performed in 40 patients, 30 of whom harbored aneurysms (18 of the ICA and 13 of the basilar artery [one patient had two aneurysms]) and 10 of whom had tumors (four large pituitary tumors, four craniopharyngiomas, and two sphenoid ridge meningiomas). The ACP was removed extradurally in 31 cases and intradurally in nine cases. Extradural clinoidectomy was performed in all cases of pituitary adenoma and craniopharyngioma and in most cases of basilar artery aneurysm. Intradural clinoidectomy was performed in two cases of ICA—ophthalmic artery aneurysm, two cases of ICA—posterior communicating artery aneurysm, two cases of ICA cavernous...
Extradural resection of the anterior clinoid process: How I do it
Neurochirurgie, 2017
Background.-The anterior clinoid process shares a close relationship with the optic canal, the internal carotid artery, the superior orbital fissure and the cavernous sinus. These structures may be involved in diseases whose surgical exposure requires prior clinoid process resection. Method.-Based on operative cases we describe the different steps of this surgical technique and illustrate our surgical procedure with a video. Dividing the orbito-temporal periosteal fold is a key-step in order to optimize the elevation of the periosteal dural layer at the level of the superior orbital fissure to expose the contours of the anterior clinoid process. The clinoid tip is removed after "debulking" the bony content inside the anterior clinoid process in order to leave only a thin shell of bony contour. The bony shell is then detached from the dura, twisted and pulled out. The indications and limitations of the technique are presented. Conclusion.-The extradural approach of the anterior clinoid process totally provides a full resection of the anterior clinoid process and safety for the paraclinoid space structures. Meticulous stepwise bony resection and optimized dura opening contribute to reduce the risk inherent to this technique.
World neurosurgery, 2017
Surgical management of lesions located in the upper clival region remains challenging. Indeed, complex open transcranial approaches have been used to reach surgical targets in these areas. From all of them, the fronto-temporo-zygomatic (FTOZ) approach combined with an intradural posterior clinoidectomy has been recently proposed as the most reliable route to manage such lesions. The aim of our study is to investigate the possibility to combine a minimally invasive endoscopic endonasal extradural posterior clinoidectomy (EPC) with a standard frontolateral approach in order to expand the working area within the upper clival region. Investigators dissected ten human cadaveric heads at the Laboratory of Surgical NeuroAnatomy of the University of Barcelona (Spain). The heads were positioned to simulate a supine position, thus enabling the simultaneous use of both endonasal and frontolateral routes. The dissections were divided in three steps: 1) standard frontolateral approach; 2) EPC; 3...
Anterior Clinoidectomy: Intradural Step-by-Step En Bloc Removal Technique
World Neurosurgery, 2021
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Skull Base, 1993
Surgery of benign intradural extra-axial tumors involving the clivus and craniospinal region is extremely demanding due to the close relationships between these tumors and vital neurovascular structures and to their frequent extension to adjacent areas. These factors call for surgical approaches that are wide enough to gain access to multiple contiguous topographic regions, multiangled to vary the surgical angle to different parts of the tumor, and that allow full control of neurovascular structures while minimizing the amount of brain retraction. In this milieu 193 Skull
Endoscopic extradural anterior clinoidectomy and optic nerve decompression through a pterional port
Journal of Clinical Neuroscience, 2014
Since the first description of the intradural removal of the anterior clinoid process, numerous refinements and modifications have been proposed to simplify and enhance the safety of the technique. The growing use of endoscopes in endonasal and transcranial approaches has changed the traditional management of many skull base lesions. We describe an endoscopic extradural anterior clinoidectomy and optic nerve decompression through a minimally invasive pterional port. Minimally invasive optic nerve decompression, with endoscopic extradural anterior clinoidectomy, through a pterional keyhole craniotomy was performed on five preserved cadaveric heads. The endoscopic pterional port provided a shorter and more direct route to the anterior clinoid region, and helped avoid unnecessary and extensive bone removal. An extradural approach helped minimize complications associated with infraction of the subdural space and allowed for the maintenance of visibility while drilling with continuous irrigation. Adequate 270°bone decompression of the optic canal was achieved in all specimens. Endoscopic extradural anterior clinoidectomy and optic nerve decompression is feasible through a single minimally invasive pterional port.