Endoscopic endonasal anterior clinoidectomy: surgical anatomy, technique nuance, and case series

Abstract

<jats:p>Advances in endoscopic technique allow for resection of the anterior clinoid process (ACP) via an endoscopic endonasal approach. The authors discuss the endoscopic endonasal anterior clinoidectomy (EEAC) and demonstrate the relevant surgical anatomy and technical nuances. The approach was simulated in 6 cadaveric heads. From a technical point of view, the lateral optic carotid recess was used as the landmark in the proposed technique. The superomedial, superolateral, and inferior vertices of this recess are the main operative points. The EEAC approach was achieved by disconnecting the ACP tip from the base by drilling the 3 vertices. The proposed approach was successfully performed in all cadaveric specimens. Then, in a case series involving 6 patients in whom the EEAC approach was used, there were no vascular injuries; 2 patients had postoperative oculomotor nerve palsy, which improved in one and resolved in the other by 1 month.</jats:p><jats:p>The EEAC approach for tumors and vascular lesions in the parasellar region is technically feasible. The surgical corridor is increased by ACP resection, although to a lesser extent than the transcranial anterior clinoidectomy. Based on the authors’ initial anatomical and surgical results, resection of the ACP via the endonasal endoscopic approach is a novel technique worth exploring in suitable cases.</jats:p>

Endoscopic Endonasal Supraoptic and Infraoptic Approaches for Complex “Parasuprasellar” Lesions: Surgical Anatomy, Technique Nuances, and Case Series

“…Skull base pathologies encompassing the suprasellar lateral area, including the lateral aspect of the planum sphenoidale and the tight junction region of the OC, ACP, and ICA and its dural rings, still pose unique surgical challenges for neurosurgeons in terms of subsequent morbidity and gross total resection (10,12,(20)(21)(22). These pathologies typically involve intra-and extracranially, tend to displace the ON from above and/or below, erode osseous and dural structures, and even involve the ICA bifurcation.…”

“…The distance between each vertex of the LOCR is measured (Table 2). With regard to safe removal of the three vertices in turn to the base of the ACP, we have specifically discussed the relevant anatomical details and surgical nuances in a previous publication (20). Once drilling of the optic strut is concluded (Figure 3E), the DDR is opened to further safely dissociate the OA.…”

Tailored Anterior Clinoidectomy: Beyond the Intradural and Extradural Concepts

“…The most frequent approach for AC reported in the literature is the pterional approach [ 10 ]. However, many approaches have also been described to access the ACP, including orbitozygomatic craniotomy, lateral supraorbital approach, and, more recently, the endoscopic endonasal approach [ 1 , 10 , 15 - 17 ].…”

Endoscopic Endonasal Supraoptic and Infraoptic Approaches for Complex “Parasuprasellar” Lesions: Surgical Anatomy, Technique Nuances, and Case Series

“…Skull base pathologies encompassing the suprasellar lateral area, including the lateral aspect of the planum sphenoidale and a tight junction region of the OC, the ACP, and the ICA and its dural rings, still pose a unique surgical challenge for neurosurgeons in terms of subsequent morbidity and achievement of gross total resection. [10,12,[20][21][22] These pathologies typically involve intra-and extracranially, tend to displace the ON from above and/or below, erode osseous and dural structures, and even involve the ICA bifurcation. Hence, TCAs for complete resection of these lesions have a high potential morbidity, even for skilled and experienced neurosurgeons.…”