Pneumatization of Anterior and Posterior clinoid processes - A preliminary study (original) (raw)
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Clinical and Investigative Medicine, 2016
Purpose: The types and ratio of anterior clinoid process (ACP) pneumatization in paranasal sinus Multidetector Computerized Tomography (MDCT) were investigated the importance of ACP in neurosurgical approaches discussed. Methods: Paranasal MDCT images of 499 subjects (259 male, 240 female), between 17 and 65 years of age, were included in the study. Presence and types of pneumatization of the ACP and pneumatization types (I, II or III) were evaluated. Results: ACP pneumatization was detected in 37.5% of the males and 33.3% of the females. Right, left and bilateral ACP pneumatizations were detected in 12.7%, 9.3% and 15.4% of males and 9.2%, 8.3% and 15.8% of the females, respectively. The most commonly detected types of pneumatization were Type I (49.1%) for right pneumatizations and Type II pneumatization for left (40.9%) and bilateral (37.2%) pneumatizations. In males, Type I (37.1%) and in females, Type II (40.0%) pneumatizations were detected more frequently. Type III pneumatization was detected in 29.9% of the males and 22.5% of the females. ACP pneumatization ratios were higher in younger subjects and lower in older subjects. Conclusion: Sclerosis process related to aging may be responsible for the lower pneumatization ratios in older subjects. When Type III ACP pneumatization is present, clinoidectomy should not be performed: in this type of ACP pneumatization, cerebrospinal fluid fistula develops in all cases.
Impact of Anterior Clinoid Process Pneumatization on Adjacent Anatomical Structures
Academia Anatomica International, 2018
The Anterior clinoid process is closely related to many important anatomical structures including vessels, nerves, and paranasal sinuses. In the majority of cases, this process is osseous, but its pneumatization has been recorded as an anatomic variant. Coronal CT scans of the head region that were done for thirty-seven patients at Tanta University hospitals were collected to be used in teaching radiological anatomy for medical students. During their routine investigation, a case of a female aged 21 years showed bilateral pneumatization of the anterior clinoid processes associated with some variants of the adjacent anatomical structures. These findings were discussed on anatomical basis with referral to their possible clinical implications. If a surgical removal of the anterior clinoid process is recommended, a comprehensive knowledge of its anatomy, pneumatization, and associated regional anatomic variants is crucial for neurosurgeons to avoid risky complications.
Folia Morphologica, 2018
Background: The anterior clinoid process (ACP) is usually removed during surgical procedures of the cellar region. The ACP may be different length and width in people; it may be also pneumatic. Therefore, we aimed to determine dimensions and rates of pneumatisation of the ACP in the large study group with clinically importance. Materials and methods: One thousand and thirty-one (592 female, 439 male) cranial computed tomography (CT) of the middle Anatolian population was used in this study. The length and basal width of the ACP were measured on the cranial CT. Also; incidence and degree of ACP pneumatisation were identified. Results: The width of the right and left ACPs in females were 10.80 ± 2.27 mm and 10.53 ± 2.07 mm, respectively. The width of the right and left ACPs in males were 11.08 ± 2.39 mm and 10.98 ± 2.35 mm, respectively. The length of the right and left ACPs in females were 8.32 ± 2.40 mm and 8.34 ± 2.35 mm, respectively. The length of the right and left ACPs in males were 8.87 ± 2.62 mm and 8.93 ± 2.64 mm, respectively. There was statistically significant difference between males and females in ACP dimensions, except for the width of the right ACP. Pneumatisation of the ACP was observed on the right side in 46 (9.3%) cases, on the left side in 53 (10.6%) cases, and bilaterally in 32 (6.5%) cases. Incidence of pneumatisation of the ACP was decreased in the age group of 1 month to 20 years. While the incidence of bilateral pneumatisation of the ACP was higher in individuals aged 21-40. Conclusions: Radiologically recognising pneumatisation and anatomical variations of the ACP may be helpful in decreasing the incidence of surgical complications during anterior clinoidectomy.
Qualitative and Quantitative Radio-Anatomical Variation of the Posterior Clinoid Process
Skull Base, 2011
This study was conducted to investigate the radiological anatomy of the posterior clinoid process (PCP) to highlight preoperative awareness of its variations and its relationships to other skull base landmarks. The PCPs of 36, three-dimensional computed tomographic cadaveric heads were evaluated by studying the gross anatomy of the PCP and by measuring the distances between the PCP and other skull base anatomical landmarks relevant to transnasal or transcranial skull base approaches. PCP variations were found in five specimens (14%): in two the dorsum sellae was absent, in one the PCP and the anterior clinoid process (ACP) were connected unilaterally and in two bilaterally. The mean distance between the right/left PCP and the crista galli was 45.14 AE 4.0 standard deviation (SD_/46.24 AE 4.5 SD, respectively, while the distance to the middle point of the basion at the level of the foramen magnum was 40.41 AE 5.1 SD/41.0 AE 5.2 SD, respectively. The mean distance between the PCP and the ACP was 12.03 AE 3.18 SD on the right side and 12.11 AE 2.77 SD on the left. The data provided highlights the importance of careful preoperative evaluation of the PCP and of its relationships to other commonly encountered skull base landmarks. This information may give an idea of the exposure achievable through different transcranial and transnasal approaches. This is especially relevant when neuronavigation is not available.
Morphometry of Anterior Clinoid Process: A Cadaveric Study
International Journal of Anatomy and Research, 2016
Surgeries in the paraclinoid region for the clinoid segment of internal carotid artery, periclinoid tumours, lesions of anterior part of cavernous sinus and traumatic optic neuropathy require the removal of anterior clinoid process to increase the accessibility to the important structures in the region. Anterior clinoidectomy is a critical and important procedure and requires utmost knowledge of the morphometry of anterior clinoid process. So, this study was undertaken to record the morphometry of anterior clinoid process (ACP). Materials and Methods: Fifty formalin-fixed cadavers were utilized from a medical college in Mumbai, Maharashtra. The measurements were done bilaterally after removal of the brain and meticulous dissection of cranial fossae was done to reflect the duramater, nerves, vessels and other structures from the field of measurement. Results: The mean distance between the tip of ACP and medial margin of the optic canal on the right side was 11.5 mm and on the left side was 11.6 mm; the mean distance between the tip of ACP and lateral margin of the optic canal on the right side was 5.4 mm and on the left side was 5.4 mm; the mean distance between medial margin of the optic canal and the lateral edge of ACP on the right side was 14.3 mm and on the left side was 14.2 mm; the mean distance between the lateral margin of the optic canal and the lateral edge of ACP on the right side was 3.3 mm and on the left side was 3.4 mm; the mean distance between the tip of ACP and the tip of posterior clinoid process (PCP) on the right side was 4.2 mm and on the left side was 4.3 mm; the mean distance between the tips of ACP was 22.8 mm; the mean distance between the ACPs at the level of lateral margin of the optic canal was 23.9 mm; the mean distance between the ACPs at the level of medial margin of the optic canal was 12.3 mm and mean vertical dimension of the ACP at the level of lateral margin of optic canal was 2.4 mm. Conclusion: The findings of the present study will help the surgeons in surgeries of the cavernous sinus and paraclinoid region requiring anterior clinoidectomy.
Morphology of the anterior clinoid process in a select Kenyan population
Anatomy journal of Africa, 2018
Knowledge of the morphological variations of the anterior clinoid process is pertinent during anterior clinoidectomy to prevent injury to the adjacent neurovascular structures as well as in the interpretation of skull base radiographs. Fifty-one open crania (102 anterior clinoid processes) were obtained from the Departments of Human Anatomy in three Kenyan Universities. Caroticoclinoid foramen was present in nine (17.6%) out of the 51 skulls studied. Of the 9 skulls, 2 had bilateral complete foramina while the remaining 7 had unilateral foramina, all on the left side. The mean length of the anterior clinoid process ranged between 5.0 and 18.8mm with a mean of 10.92±2.79 mm. The mean width was found to be 10.43±2.67 mm (range: 5.3-18.0mm) while the average thickness was 5.43±2.02mm (range: 1.3-11.9mm). There were no statistically significant side differences in the dimensions of the anterior clinoid process. Type IIIb anterior clinoid process was the commonest (47.1%) while type IIIa was the least common (7.8%). Compared to other populations, the anterior clinoid process in our setting shows some differences involving its type and the caroticoclinoid foramen. These features should be taken into account when interpreting skull base radiographs and planning for anterior clinoidectomies.
AlQalam Journal of Medical and Applied Sciences, 2024
The anterior clinoid process (ACP) has a complex anatomical feature and surrounded by important structures which may complicate the surgical procedures during the anterior clinoidectomy. Our objective was to measure dimensions of anterior clinoid process, and to determine variations of its types. Forty-nine of cranial computed tomography scans were performed from adult Libyan patients on routine examination of paranasal sinus at Benghazi Medical Center between February 1, 2023, and April 14, 2023. The right and left ACP length and the base width were measured on the axial CT images. Data analysis was done using SPSS version 23. The means and standard deviations were calculated. The paired Student's t test was used to determine the statistically significant differences in means between the right and left ACP. (P ≤ 0.05) was considered statistically significant at (95%) confidence interval. The length of the right and left ACPs were 11.2 ± 2.2 mm and 11.6 ± 2.4mm, respectively. The width of the right and left ACPs were 5.37± 1.22 mm and 5.42 ± 1.24mm, respectively. Type 2 anterior clinoid process was the commonest (75.5 %) while type 1 was the least common (4.1 %). There was no statistically significant difference between right and left sided measurements. Our study outcomes may be helpful for pre-operative planning. Presence of any variations may result in unnecessary injury to the complicated surgical procedures that involve removal of ACPs. Further research studies required with large sample size of population will give well understanding about the parameter of ACPs.
International Journal of Approximate Reasoning, 2017
Address for Correspondence: Dr M Janardhan Rao, Associate Professor, Department of Anatomy, Kamineni Academy of Medical Sciences and Research Center, L B Nagar, Hyderabad, Telangana, India. Contact number: 09030504816 E-Mail: drmjr.kams@gmail.com Introduction: Anterior clinoidectomy is a surgical removal of the anterior clinoid process which is widely used to increase the clinoid space for the treatment of internal carotid artery or ophthalmic artery aneurysms, tumors of this region, and cavernous sinus pathology. Morphometric analysis of the anterior clinoid process would help the neurosurgeons while performing extradural or intradural anterior clinoidectomy. Materials and Methods: The present study was consisting of 100 anterior clinoid processes in 50 adult human skulls of South Indian origin. The skull caps were removed and the skulls with damage or pathology near the sella turcica and anterior clinoid process were excluded from the study. All the parameters were measured by usi...
Morphological Variation of Anterior Clinoid Process in Dry Human Skulls
Birat Journal of Health Sciences, 2020
Introduction: The anatomical relationship of the Anterior Clinoid Process (ACP) with its neighboring structures in the base of the skull is complex with different variations. Thus, study of its morphology is essential in defining and directing surgery. Objective: This study aims to investigate the anatomy of the anterior clinoid process and prevalence of Caroticoclinoid foramen (CCF) to highlight its variations. Methodology: The measurements were performed in 31 dry human skulls to define the structure of ACP, the presence of CCF and other relevant landmarks using digital Vernier Calipers. Results: The mean length, basal width and thickness of the right ACP was 9.88+/- 1.36 mm, 8.72+/-1.50 mm, and 5.21+/-1.83 mm respectively and that of the left was 10.30+/-1.47, 8.73+/-1.71, and 5.33+/-1.60 mm respectively. Paired t-test was used to compare the mean of these sides. Type III was the most common form of ACP for both the sides. Out of 31 skulls, CCF was observed in 12 (38.7%) skulls ...
Morphometry of the posterior clinoid process and dorsum sellae
Ceska A Slovenska Neurologie A Neurochirurgie, 2018
Aims: The posterior clinoid process (PCP) is a paired anatomic structure located in the middle cranial fos sa on the superior surface of the sphenoid bone where it forms a bony eminence that is the lateral boundary of the dorsum sel lae (DS). The aim of the study was to analyse PCP and DS morphometry in CT. Materials and methods: The study was based on 100 CT investigations of 54 women and 46 men aged 18-88 years (mean age 52.49 years). The PCP and DS morphometry was studied in coronal and sagittal planes. Data were analysed statistical ly in relation to patients' gender and age (group 1: up to 45 years, group 2: over 45 years). Results: The average width of the right and left PCP was 10.2 mm and 9.85 m m, resp., while the average height of the right and left PCP was 2.32 mm and 2.04 m m, resp. The thickness of the DS superior edge was 3.29 m m, and of the right and left PCP 4.28 mm and 4.31 m m, resp. Statistical calculations led to the conclusion that the right PCP was wider and thicker in men. Moreover, the DS superior edge is also thicker in men, and the left PCP is wider and higher in people over 45 years of age. Conclusions: The PCP and DS are dif erent in men and women: 1. The right PCP is wider and thicker in men than in women; 2. The superior edge of the DS is thicker in men than in women; 3. The width and height of the left PCP reach higher values in patients over 45 years of age compared to those below 45 years of age. Souhrn Cíle: Proces sus clinoideus posterior (PCP) je párová anatomická struktura situovaná ve střední jámě lební na horní straně klínové kosti, kde tvoří kostní výběžek, který představuje laterální hranici dorsum sel lae (DS). Cílem studie bylo analyzovat morfometrii PCP a DS pomocí CT. Materiály a metody: Studie byla provedena na základě analýzy sta snímků pořízených CT u 54 žen a 46 mužů ve věku 18-88 let (průměrný věk 52,49 let). Na snímcích byla analyzována morfometrie PCP a DS v koronální a sagitální rovině. Získaná data byla statisticky analyzována ve vztahu k pohlaví a věku pa cientů (skupina 1: pa cienti do 45 let, skupina 2: pa cienti starší 45 let). Výsledky: Průměrná šířka byla 10,2 mm u pravého PCP a 9,85 mm u levého PCP. Průměrná výška pravého PCP byla 2,32 mm a průměrná výška levého PCP 2,04 m m. Tloušťka horního okraje DS byla 3,29 mm a tloušťka pravého a levého PCP byla 4,28 mm a 4,31 m m. Statistické výpočty ukázaly, že pravý PCP je u mužů širší a silnější. Stejně tak horní okraj DS byl silnější u mužů a levý PCP byl širší a vyšší u osob starších 45 let. Závěry: Mezi PCP a DS mužů a žen existují rozdíly: 1. Pravý PCP je širší a silnější u mužů než u žen; 2. Horní okraj DS je silnější u mužů než u žen; 3. Šířka a výška levého PCP dosahovala vyšších hodnot u pa cientů starších 45 let oproti skupině pa cientů ve věku do 45 let.