Orbitopterional approach with extradural clinoidectomy for the resection of a tuberculum sellae meningioma. Advances in endoscopic technique allow for resection of the anterior clinoid process acp via an endoscopic endonasal approach. Description of the extradural clinoidectomy and its ability to expand the opticocarotid and carotidoculomotor windows to facilitate surgical approach. Anterior clinoidectomy is an important tool for neurovascular and. In this chapter, advantages, indications, technical details and complications are. Extended middle fossa approach with anterior petrosectomy. Anterior clinoid drilling operative video 2 youtube. Extradural clinoidectomy the neurosurgical atlas, by aaron. The pterional approach and extradural anterior clinoidectomy to. Removal of the anterior clinoid process expands the anterolateral corridor. Anterior clinoidectomy surgical neurology international.
Resection of the anterior clinoid process acp is essential when the clinoidal or supraclinoidal segment of internal carotid artery ica needs to be exposed in the. The sphenoid sinus projects into the optic strut and into the base of the anterior clinoid process. Anterior clinoidectomy is an important technique for neurovascular and skull base surgery. B, illustration showing the neurosurgeons perspective through a left pterional craniotomy.
Pdf endoscopic extradural anterior clinoidectomy and. Surgical clipping of paraclinoid aneurysms involving the anterior clinoid process acp can present great challenges because strong adhesion may. In addition to an operative video, the anatomy and surgical technique is demonstrated in virtual reality space to enhance the. This case demonstrates the importance of anterior clinoidectomy and thorough distal. Orbitomeningeal band in transcavernous dissection and anterior clinoidectomy. Performed extradurally, the dura provides intracranial contents some protection. Endoscopic endonasal transcavernous posterior clinoidectomy with interdural pituitary transposition. Right orbitozygomatic craniotomy with extradural anterior clinoidectomy. Anterior clinoidectomy university of miamis research. It affords a generous working and viewing angle, but it can be technically challenging and requires attention to detail at each step. Intradural anterior clinoidectomy for ophthalmic artery aneurysm clipping.
At 8week followup, the patient was able to walk without assistance and her vision remained unchanged. This video demonstrates clip occlusion of an unruptured right carotid cave. Tailored anterior clinoidectomy through the lateral supraorbital approach. Pdf extradural clinoidectomy for resection of clinoidal. The pterional approach and extradural anterior clinoidectomy to clip paraclinoid aneurysms jung soo kim, sunil lee, kyoung dong jeon, byeong sam choi department of neurosurgery, haeundae paik hospital, inje university colleage of medicine, busan, korea objective. Our experiences of pterional craniotomy and extradural anterior clinoidectomy eac to. It is of particular use in the resection of clinoidal meningiomas, as sphenoidal and clinoidal hyperostosis can cause compression of the optic nerve. Microsurgical clipping of an ophthalmic artery aneurysm with a limited intradural anterior clinoidectomy. Characteristics of patients with nonarteritic anterior ischemic optic neuropathy eligible for the ischemic optic neuropathy decompression trial. Right unruptured icaopthalmic aneurysm, extradural anterior clinoidectomy ali krisht, md, phd. Power drilling commonly used for anterior clinoidectomy and optic canal unroofing can result in thermal injury to the optic nerve. Cureus transcavernous approach to the basilar apex. The surgical clipping of paraclinoid segment internal carotid artery aneurysms is considered difficult because of the complex anatomical location and important neighboring structures.
We investigate this approach in this report via a cadaveric prosection with a focus on the value of each of the. Extradural removal of the anterior clinoid process acp is an important step in surgical access to the lesions involving the central skull base, especially, sellar and. Pdf endoscopic extradural anterior clinoidectomy and optic nerve. Pdf anterior clinoidectomy for large icpc aneurysms. The authors discuss the endoscopic endonasal anterior clinoidectomy eeac and demonstrate the relevant surgical anatomy and technical nuances. Endoscopic extradural anterior clinoidectomy and optic nerve. This video demonstrates a cadaver dissection with intradural anterior clinoidectomy.
Anterior clinoidectomy and microsurgical clipping of a. Until now, extradural anterior clinoidectomies have been performed. Extended middle fossa approach with anterior petrosectomy and anterior clinoidectomy for resection of sphenocavernoustentorial meningioma. Orbitopterional approach with extradural clinoidectomy. To overcome this, a host of adjuncts to these approaches has been utilized including orbital osteotomies, anterior clinoidectomy, ica mobilization, and. Id do intradural clinoidectomy in ophthalmic and sup.
Optic nerve decompression surgery medical clinical. Anterior clinoidectomy removes all bone above the dashed line, which then communicates the subarachnoid space with the sphenoid sinus. Anterior clinoidectomy is then performed under endoscopic view, and the superior orbital fissure sof is also opened by drilling. Anterior clinoidectomy in skull base technique anterior clinoidectomy in skull base technique zhu, wei. Anterior clinoidectomy is a difficult but important part of surgery for a variety of parasellar, proximal carotid and central skull base pathologies. We think the use of a highspeed drill would be better suited to resection of large amounts of bone via a. Operative video demonstrating the acth technique in the case of a paraclinoid aneurysm. In this video abstract, we present an intradural anterior clinoidectomy for management of some paraclinoid aneurysms.
Extradural clinoidectomy the neurosurgical atlas, by. Extradural clinoidectomy for resection of clinoidal. Drilling of the anterior clinoid process acp is an integral component of surgical approaches for central and. First developed intradurally nearly 60 years ago, the promotion of an extradural technique decades later offered an approach with a different set of difficulties, risks and benefits.
Anterior clinoidectomy and opening of the internal auditory canal were completed within 30 minutes, although the time required depends on the volume and hardness of bone to be resected. Additionally, the original dolenc procedure and its subsequent derivatives are compared and contrasted to the authors simpler and less laborious technique. The sphenoid ridge sr is identified, and the bone lateral to the orbit is drilled off until the anterior aspect of the temporal dura mater appears. Intradural anterior clinoidectomy for ophthalmic artery aneurysm.
Anterior clinoidectomy for paraclinoid aneurysms in. Video article microsurgical clipping of an unruptured carotid cave. Critical to understand and utilize the extradural and intradural technique for the advantage of minimizing injury to adjacent structures. The anatomy of the anterior clinoid process is described along with variants of the surrounding structures.
How to perform selective extradural anterior clinoidectomy. The main disadvantage of the extradural anterior clinoidectomy is the lack of direct visual control of critical adjacent neurovascular anatomy that is, ica and optic nerve. The transcavernous approach to the basilar artery, as initially described by dolenc, is one of the most common and elegant approaches to the region. Extradural and intradural drilling of acp contains operative videos. The surgical clipping of paraclinoid segment internal carotid. Our experiences of pterional craniotomy and extradural anterior clinoidectomy eac to clip paraclinoid aneurysms are reported herein. Ashish suri, professor of neurosurgery, aiims, new delhi shows how he does anterior clinoid drilling. With this method one may obviate the more invasive and time consuming technique of extensive orbital roof removal together with anterior clinoidectomy which had been applied in surgical treatment for parasellar and cavernous pathologies pioneered by dolenc 2, 3. Complications of anterior clinoidectomy through lateral. Minimally invasive extradural anterior clinoidectomy and optic nerve decompression.
Anterior clinoidectomy is a key microsurgical step for the successful and safe management of paraclinoid aneurysms and parasellar neoplastic lesions 3, 4, 37. Quantitative analysis of variable extent of anterior clinoidectomy. For extradural resection of the anterior clinoid process and surrounding bone, two key steps are recommended. Anterior clinoidectomy using an extradural and intradural. The neurosurgical atlas is committed to promoting neurosurgical education free of charge. There is no charge to read or download any sni content, but registering for a free membership will.
We analyzed the operative videos paying particular attention to the surgical technique used for removal of the anterior clinoid process acp and compared the microsurgical nuances to postoperative complications related to anterior clinoidectomy. When the aneurysm is large or the distance between the anterior clinoid process and the aneurysmal. Endoscopic extradural anterior clinoidectomy and optic nerve decompression through a pterional port. Extradural anterior clinoidectomy and aneurysm clipping usin. Emphasis is placed on microsurgical anatomy, the intradural anterior clinoidectomy and clipping technique. Extradural anterior clinoidectomy is a versatile technique to increase exposure of the sellar and parasellar region. Microsurgical clipping of an ophthalmic artery aneurysm. Here, the authors present a 3dimensional video of the microsurgical steps required to perform anterior clinoidectomy, which are the key steps to treat an aneurysm in the paraclinoid segment of the internal carotid artery. Orbitomeningeal band in transcavernous dissection and. For complete and safe clipping, some require anterior clinoidectomy. Quick adenosine cardiac arrest performed instead of an anterior clinoidectomy and proximal temporary clipping usually allows us a proximal control of aneurysms in helsinki neurosurgery. Anterior clinoidectomy and opening of the internal auditory canal using an ultrasonic bone curette. Tailored anterior clinoidectomy through the lateral. Intraoperative fluoroscopic indocyanine green video angiography icgva is a well described and widely used method to evaluate the vasculature and aneurysm before and after clip placement.
This video demonstrates extradural anterior clinoidectomy with clipping of wide necked ophthalmic segment aneurysm as. Intradural anterior clinoidectomy for ophthalmic artery. This video demonstrates the clip reconstruction of a giant thrombotic ophthalmic artery aneurysm that was previously treated with wrapping and stentassisted co. Optic nerve decompression surgery for nonarteritic anterior ischemic optic neuropathy naion is not effective and may be harmful. There is no charge to read or download any sni content, but registering for a free membership will provide you with additional special features. Anterior clinoidectomy was successfully performed in all. This video has been taken from quantitative analysis of variable extent. Technical description of minimally invasive extradural. Microsurgical treatment of ophthalmic segment aneurysms. Right unruptured icaopthalmic aneurysm, extradural. Anterior clinoidectomy and opening of the internal. This article provides a depiction of microsurgical treatment of ophthalmic segment aneurysms with an accompanying video demonstration. Anterior clinoidectomy using an extradural and intradural 2step. Suction decompression during anterior clinoidectomy for direct.
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