Calcified interclinoid ligament: An unusual cause of misinterpretation on cerebral CT angiography

Vk, Gupta; Khandelwal, N; Mathuria, S.N.; Palash, J. Das

doi:10.1016/j.crad.2013.03.019

Cited by 1 publication

(2 citation statements)

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“…Potential association with interclinoid mineralisation and age. Gupta et al [ 38 ] 1 India – – – – Case report—misidentification of a mineralised interclinoid ligament as para-posterior communicating artery aneurysm. Keyes 1935 [ 12 ] 2187 dry skulls USA 1 day–105 years – – 8.68% Details of the anatomical features of mineralised ligament.…”

Section: Resultsmentioning

confidence: 99%

“…In addition, the presence of a completely mineralised caroticoclinoid ligament may alter the appearance of the middle clinoid process, which can be used as landmark for the anteromedial roof of the cavernous sinus and transition between the cavernous and clinoid segments of the internal carotid artery during endoscopic endonasal approaches to the pituitary gland [ 5 , 6 ]. Furthermore, the presence of high-density calcification in the parasellar region may cause confusion on CT angiography if the viewer is unfamiliar with skull base ligamentous mineralisation; indeed, mineralisation of the interclinoid has been confused with para-posterior communicating artery aneurysm [ 38 ]. Finally, ‘sellar bridges’ have been associated with dental and other developmental abnormalities, including Gorlin-Goltz syndrome [ 26 , 40 , 42 , 72 , 73 ].…”

Section: Discussionmentioning

confidence: 99%

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Skull base ligamentous mineralisation: evaluation using computed tomography and a review of the clinical relevance

et al. 2019

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Objectives To determine the frequency, morphologic and demographic characteristics, and clinical relevance of the mineralisation of six skull base ligaments (interclinoid, caroticoclinoid, petrosphenoid, posterior petroclinoid, pterygospinous, and pterygoalar). Methods This is a retrospective review of 240 CT scans of the paranasal sinuses (ages 6–80 years). A limited systematic review was performed primarily using Embase and Medline databases. Results Ligamentous mineralisation was well delineated on CT and occurred at ≥ 1 location in 58.3% of patients. There was a nonsignificant trend towards a greater incidence with advancing age. The interclinoid and posterior petroclinoid ligaments were most commonly mineralised (22.1% and 18.3%, respectively); the petrosphenoid and pterygoalar ligaments were least frequently mineralised (10.8% and 6.3%, respectively). The mean age of patients with posterior petroclinoid mineralisation was significantly greater than those with interclinoid and petrosphenoid mineralisation and was not seen in patients aged 6–20 years. The literature review highlighted the clinically relevant potential for mineralised ligaments to cause barriers to surgical access (e.g. to the foramen ovale), increase the risk of neurovascular injury during surgery at the skull base (e.g. during anterior clinoidectomy), and predispose to neural impingement. Conclusions Skull base ligamentous mineralisation is commonly encountered on CT imaging. Given the potentially significant clinical implications, an understanding of the morphological appearances is of importance to those planning interventions at the skull base. To the authors’ knowledge, this study is the first to comprehensively evaluate such a wide range of skull base ligaments using CT. For some ligaments, the incidence on CT has not been previously described.

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