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Byoun HS, Choi KS, Na MK, Kwon SM, Nam YS. The Usefulness of Extradural Anterior Clinoidectomy for Lower-Lying Posterior Communicating Artery Aneurysms : A Cadaveric Study. J Korean Neurosurg Soc 2024; 67:411-417. [PMID: 38061762 PMCID: PMC11220413 DOI: 10.3340/jkns.2023.0184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/13/2023] [Accepted: 12/05/2023] [Indexed: 07/04/2024] Open
Abstract
OBJECTIVE To confirm the usefulness of the extradural anterior clinoidectomy during the clipping of a lower riding posterior communicating artery (PCoA) aneurysm through cadaver dissection. METHODS Anatomic measurements of 12 adult cadaveric heads (24 sides total) were performed to compare the microsurgical exposure of the PCoA and internal carotid artery (ICA) before and after clinoidectomy. A standard pterional craniotomy and transsylvian approach were performed in all cadavers. The distance from the ICA bifurcation to the origin of PCoA (D1), pre-anterior clinoidectomy distance from the ICA bifurcation to tentorium (D2), post-anterior clinoidectomy distance from the ICA bifurcation to tentorium (D3), pre-anterior clinoidectomy distance from the tentorium to the origin of PCoA (D4) and post-anterior clinoidectomy distance from the tentorium to the origin of PCoA (D5) and the distance of the ICA obtained after anterior clinoidectomy (D6) were measured. We measured the precise thickness of the blade for the Yasargil clip with a digital precision ruler to confirm the usefulness of the extradural anterior clinoidectomy. RESULTS Twenty-four sites were dissected from 12 cadavers. The age of the cadavers was 79.83±6.25 years. The number of males was the same as the females. The space from the proximal origin of the PCoA to the preclinoid-tentorium (D4) was 1.45±1.08 mm (max, 4.01; min, 0.56). After the clinoidectomy, the space from the proximal origin of the PCoA to the postclinoid-tentorium (D5) was 3.612±1.15 mm (max, 6.14; min, 1.83). The length (D6) of the exposed proximal ICA after the extradural clinoididectomy was 2.17±1.04 mm on the lateral side and 2.16±0.89 mm on the medial side. The thickness of the Yasargil clip blade used during the clipping surgery was 1.35 mm measured with a digital precision ruler. CONCLUSION The proximal length obtained by performing an external anterior clinoidectomy is about 2 mm, sufficient for proximal control during PCoA aneurysm surgery, considering the thickness of the aneurysm clips. In a subarachnoid hemorrhage, performing an extradural anterior clinoidectomy could prevent a devastating situation during PCoA aneurysm clipping.
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Affiliation(s)
- Hyoung Soo Byoun
- Department of Neurosurgery, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Kyu-Sun Choi
- Department of Neurosurgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Min Kyun Na
- Department of Neurosurgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Sae Min Kwon
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Yong Seok Nam
- Department of Anatomy, College of Korean Medicine, Dongshin University, Naju, Korea
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Chen H, Xu Y, Shi J, Zhang Y, Qian C, Luo Z. The Extended Pterional Approach Allows Satisfactory Results for the Resection of Huge Medial Sphenoid Ridge Meningioma. World Neurosurg 2023; 176:e306-e313. [PMID: 37224955 DOI: 10.1016/j.wneu.2023.05.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 05/15/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To investigate the surgical method and efficacy of the extended pterional approach in the resection of huge medial sphenoid ridge meningiomas (MSRMs). METHODS Retrospective analysis of clinical data from 41 patients diagnosed with MSRMs (diameter ≥4.0 cm) from Nanjing Brain Hospital between January 2012 and February 2022 was conducted. Within 24 hours after surgery, head computed tomography and magnetic resonance imagingwere reviewed to evaluate the extent of tumor resection based on Simpson grading. Cranial magnetic resonance imagingwas repeated 3 to 60 months after surgery to assess tumor recurrence or progression. Preoperative, discharge, and follow-up Karnofsky functional status scores (KPS) were assessed to determine patients' functional status. Repeated-measures analysis of variance was utilized to compare KPS at preoperative, hospital discharge, and final follow-up. RESULTS The 41 selected cases included 38 cases (92.7%) of Simpson I-III resection and 3 cases (7.3%) of Simpson IV resection. All the cases had typical pathological features and definite pathological diagnoses. There were 2 recurrent tumors and 4 progressed tumors when the patients were followed up from 3 months to 60 months after operations. The results demonstrated that the KPS score at the final follow-up (91.4 ± 9.6) was higher than at hospital discharge (85.3 ± 8.9) and preoperation (78.2 ± 8.5) (F = 69.46, P = 0.033). CONCLUSIONS The use of the extended pterional approach in the resection of huge MSRMs appears to be an effective surgical method. Careful dissection and preservation of vascular and neural structures, as well as meticulous microsurgical techniques in managing cavernous sinus tumors, can lead to reduced surgical complications and improved treatment outcomes.
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Affiliation(s)
- Hairong Chen
- Department of Neurosurgery, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Yang Xu
- Department of Neurosurgery, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Jianwei Shi
- Department of Neurosurgery, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Yansong Zhang
- Department of Neurosurgery, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Chunfa Qian
- Department of Neurosurgery, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Zhengxiang Luo
- Department of Neurosurgery, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China.
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Kimura T, Takeda Y, Ichi S. Modified extradural selective anterior clinoidectomy leaving the optic canal unopened for internal carotid aneurysms: A technical note. World Neurosurg X 2023; 18:100154. [PMID: 36785622 PMCID: PMC9918798 DOI: 10.1016/j.wnsx.2023.100154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/10/2023] [Indexed: 01/21/2023] Open
Abstract
Background Anterior clinoidectomy is an established procedure used to decompress the optic nerve, mobilize the internal carotid artery (ICA), or enlarge the retrocarotid space. However, its use carries the risk of optic nerve injury. In certain surgeries, such as those for internal carotid aneurysms, propose modification to the anterior clinoidectomy for enlarging the retrocarotid space, especially in operations for ICA aneurysms. Methods After the anterior clinoid process (ACP) is sufficiently exposed, the internal cancellous bone or pneumatization can be removed through a small window created at its lateral edge to reveal the compact bone of the optic canal. Since the compact bone of the inferior surface facing the ICA is absent or very thin, the ACP can be removed by drilling through the anchoring compact bone with the optic canal in direct sight. Results In 10 consecutive internal carotid aneurysm cases, the ACP was successfully removed without opening of the optic canal to enlarge the retrocarotid space. Conclusions Anterior clinoidectomy can be performed to enlarge the retrocarotid space without opening the optic canal from outside the dura.
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Affiliation(s)
- Toshikazu Kimura
- Corresponding author. Department of Neurosurgery, Japanese Red Cross Medical Center 4-1-22 Hiroo, Shibuya City, Tokyo 150-8935, Japan.
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Tayebi Meybodi A, Mignucci-Jiménez G, Lawton MT, Liu JK, Preul MC, Sun H. Comprehensive microsurgical anatomy of the middle cranial fossa: Part I-Osseous and meningeal anatomy. Front Surg 2023; 10:1132774. [PMID: 37035561 PMCID: PMC10080110 DOI: 10.3389/fsurg.2023.1132774] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/27/2023] [Indexed: 04/11/2023] Open
Abstract
The middle cranial fossa is one of the most complex regions in neurosurgery and otolaryngology-in fact, the practice of skull base surgery originated from the need to treat pathologies in this region. Additionally, great neurosurgeons of our present and past are remembered for their unique methods of treating diseases in the middle fossa. The following article reviews the surgical anatomy of the middle fossa. The review is divided into the anatomy of the bones, dura, vasculature, and nerves-in two parts. Emphasis is paid to their neurosurgical significance and applications in skull base surgery. Part I focuses on the bony and dural anatomy.
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Affiliation(s)
- Ali Tayebi Meybodi
- Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ, United States
- Correspondence: Ali Tayebi Meybodi ;
| | - Giancarlo Mignucci-Jiménez
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, United States
| | - Michael T. Lawton
- Departments of Neurosurgery and Otolaryngology, Robert Wood Johnson Barnabas Health, Newark, NJ, United States
| | - James K. Liu
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, United States
| | - Mark C. Preul
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, United States
| | - Hai Sun
- Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ, United States
- Departments of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, United States
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Shaftel KA, Przybylowski CJ, Little AS. Endoscopic Endonasal Transsphenoidal Approach to Repair Cerebrospinal Fluid Rhinorrhea After an Anterior Clinoidectomy for Aneurysm Clipping: Series of 4 Cases. Oper Neurosurg (Hagerstown) 2023; 24:17-22. [PMID: 36227187 DOI: 10.1227/ons.0000000000000430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 07/16/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Cerebrospinal fluid (CSF) rhinorrhea through a pneumatized optic strut is a known potential complication after an anterior clinoidectomy that is used to microsurgically clip a proximal internal carotid artery aneurysm. The original craniotomy site can be reopened to repair the skull base defect, but this technique has disadvantages. OBJECTIVE To avoid a repeat craniotomy and address the limitations of a transcranial approach, a straightforward alternative was used for skull base repair-the binostril endoscopic endonasal transsphenoidal approach. METHODS This retrospective case series describes the use of endoscopic transsphenoidal repair and outcomes for patients with CSF leaks after anterior clinoidectomy for aneurysm repair between January 1, 2015, and December 31, 2019. RESULTS Four adult patients (3 women and 1 man) with a mean age of 59.5 years were reviewed. Skull base repair occurred on average 24 days (range, 4-75 days) after the index operation. After demucosalization of the parasellar sphenoid sinus, the fistula in the pneumatized optic strut was reconstructed with a free nasal mucosal graft with or without an autologous muscle graft. None of the patients developed a recurrent CSF leak at a mean follow-up of 12.5 months (range, 8-22 months), and none experienced complications. CONCLUSION The endoscopic endonasal transsphenoidal approach was safe and effective for skull base repair in 4 patients with CSF rhinorrhea after an anterior clinoidectomy for aneurysm clipping.
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Affiliation(s)
- Kelly A Shaftel
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Lim J, Sung KS, Yoo J, Oh J, Moon JH. Endoscopic transorbital extradural anterior clinoidectomy: A stepwise surgical technique and case series study [SevEN-013]. Front Oncol 2022; 12:991065. [PMID: 36106107 PMCID: PMC9465428 DOI: 10.3389/fonc.2022.991065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/08/2022] [Indexed: 11/29/2022] Open
Abstract
Background Anterior clinoidectomy is an important procedure for approaching the central skull base lesions. However, anterior clinoidectomy through the endoscopic transorbital approach (ETOA) still has limitations due to technical difficulties and the structural complexity of the anterior clinoid process (ACP). Therefore, the authors designed a stepwise surgical technique of extradural anterior clinoidectomy through the ETOA. The purpose of this study was to evaluate the feasibility of this technique. Methods Anatomical dissections were performed in 6 cadaveric specimens using a neuroendoscope and neuro-navigation system. The extradural anterior clinoidectomy through the ETOA was performed stepwise, and based on the results, this surgical technique was performed in the 7 clinical cases to evaluate its safety and efficiency. Results Endoscopic extradural anterior clinoidectomy was successfully performed in all cadaveric specimens and patients using the proposed technique. This 5-step technique enabled detachment of the lesser wing of sphenoid bone from the ACP, safe unroofing of the optic canal, and resection of the optic strut without injuring the optic nerve and internal carotid artery. Since the sequential resection of the 3 supporting roots of the ACP was accomplished safely, anterior clinoidectomy was then successfully performed in all clinical cases. Furthermore, no complications related to the anterior clinoidectomy occurred in any clinical case. Conclusion We designed a stepwise surgical technique that allows safe and efficient anterior clinoidectomy through the ETOA. Using this technique, extradural anterior clinoidectomy can be accomplished under direct endoscopic visualization with low morbidity. Since this technique is applicable to the central skull base surgery where anterior clinoidectomy is necessary, it expands the application of the ETOA.
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Affiliation(s)
- Jaejoon Lim
- Department of Neurosurgery, Bundang CHA Medical Center, CHA University College of Medicine, Seongnam, South Korea
| | - Kyoung Su Sung
- Department of Neurosurgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, South Korea
| | - Jihwan Yoo
- Department of Neurosurgery, Brain Tumor Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jiwoong Oh
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Ju Hyung Moon
- Department of Neurosurgery, Endoscopic Skull Base Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
- *Correspondence: Ju Hyung Moon,
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Modified intradural anterior clinoidectomy to protect the paraclinoid neurovascular structures: a technical note. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Surgical management of anterior clinoidal meningiomas: consensus statement on behalf of the EANS skull base section. Acta Neurochir (Wien) 2021; 163:3387-3400. [PMID: 34398339 PMCID: PMC8599327 DOI: 10.1007/s00701-021-04964-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/04/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND The optimal management of clinoidal meningiomas (CMs) continues to be debated. METHODS We constituted a task force comprising the members of the EANS skull base committee along with international experts to derive recommendations for the management of these tumors. The data from the literature along with contemporary practice patterns were discussed within the task force to generate consensual recommendations. RESULTS AND CONCLUSION This article represents the consensus opinion of the task force regarding pre-operative evaluations, patient's counselling, surgical classification, and optimal surgical strategy. Although this analysis yielded only Class B evidence and expert opinions, it should guide practitioners in the management of patients with clinoidal meningiomas and might form the basis for future clinical trials.
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López CB, Di Somma A, Cepeda S, Arrese I, Sarabia R, Agustín JH, Topczewski TE, Enseñat J, Prats-Galino A. Extradural anterior clinoidectomy through endoscopic transorbital approach: laboratory investigation for surgical perspective. Acta Neurochir (Wien) 2021; 163:2177-2188. [PMID: 34110491 DOI: 10.1007/s00701-021-04896-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 05/26/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The endoscopic transorbital approach (eTOA) is a new mini-invasive procedure used to explore different areas of the skull base. Authors propose an extradural anterior clinoidectomy (AC) through this corridor, defining the anatomical landmarks of the anterior clinoid process (ACP) projection onto the posterior orbit wall and the technical feasibility of this approach. We describe the exposure of the opticocarotid region and the surgical freedom and the angles of attack obtained with this novel approach. METHODS Five cadaver heads underwent an eTOA at the Laboratory of Surgical Neuroanatomy of the University of Barcelona. A step-by-step description of the extradural endoscopic transorbital clinoidectomy was provided. A volumetric analysis of the morphometrics characteristics of the sphenoid wings was evaluated before and after dissection using CT scans. Pterional approach was performed to ascertain ACP removal. RESULTS In all the specimens, it was possible to resect the ACP endo-orbitally aiming an optimal optic canal (OC) unroofing. The surface of the triangle corresponding to the ACP projection onto the posterior orbit wall was 0.42 ± 0.20 cm2. The drilled area to perform the extradural clinoidectomy via eTOA was 3.11 ± 2.27 cm2, and the volume of bone removal corresponding to the greater sphenoid wing (GSW) and lesser sphenoid wing (LSW) was 2.55 ± 1.41 and 0.26 ± 0.18 cm3 respectively. The area of surgical freedom provided by the eTOA was (3.11 ± 2.27cm2), and the angles of attack were 21.39 ± 9.13° in the horizontal axel and 30.63 ± 18.51° in the vertical. CONCLUSIONS The described extradural anterior clinoidectomy by eTOA uses specific landmarks to localize the ACP on the posterior orbit wall. Resection of the ACP is a technically feasible approach, achieving the main goals of any clinoidectomy.
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Affiliation(s)
| | - Alberto Di Somma
- Department of Neurosurgery, Hospital Clinic, Barcelona, Spain.
- Laboratory of Surgical Neuroanatomy, Faculty of Medicine, University of Barcelona, Barcelona, Spain.
- Department of Neurological Surgery, Institut Clínic de Neurociències (ICN), Hospital Clínic de Barcelona, Carrer de Villaroel, 170, 08036, Barcelona, Spain.
| | - Santiago Cepeda
- Department of Neurosurgery, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Ignacio Arrese
- Department of Neurosurgery, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Rosario Sarabia
- Department of Neurosurgery, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Javier Herrero Agustín
- Department of Otolaryngology-Head and Neck Surgery, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Thomaz E Topczewski
- Department of Neurosurgery, Hospital Clinic, Barcelona, Spain
- Laboratory of Surgical Neuroanatomy, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Joaquim Enseñat
- Department of Neurosurgery, Hospital Clinic, Barcelona, Spain
| | - Alberto Prats-Galino
- Laboratory of Surgical Neuroanatomy, Faculty of Medicine, University of Barcelona, Barcelona, Spain
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Gonçalves Pacheco Junior M, de Melo Junior JO, André Acioly M, Mansilla Cabrera Rodrigues R, Lima Pessôa B, Fernandes RA, Landeiro JA. Tailored Anterior Clinoidectomy: Beyond the Intradural and Extradural Concepts. Cureus 2021; 13:e14874. [PMID: 34104602 PMCID: PMC8179565 DOI: 10.7759/cureus.14874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Anterior clinoidectomy (AC) is a key microsurgical step for the safe and successful management of parasellar pathologies that involve the anterior clinoid process (ACP) and the optic canal. Traditionally, extra and intradural ACs are performed separately according to the surgeon's experience or preference. The objective is to present and discuss the tailored AC concept through illustrative cases. We conducted a retrospective record review of three patients who underwent AC as a surgical step for the treatment of parasellar pathologies that involve the ACP and optic canal. A review of the relevant literature on AC was performed in the PubMed, LILACS, and SciELO databases. In all three cases, the pterional craniotomy was the preferred approach for AC. Case 1, a 47-year-old female patient with type III anterior clinoidal meningioma, underwent a tailored intradural technique (optic canal unroofing) with total tumor resection and complete visual recovery. Case 2, a 63-year-old female patient with a complex type II anterior clinoidal meningioma with extensive hyperostosis of the ACP, underwent a hybrid AC technique with complete removal of the tumor and visual improvement. Case 3, a 62-year-old female, underwent a tailored intradural AC for clipping an incidental carotid-ophthalmic aneurysm. Tailored AC aims to provide adequate exposure with less risk of neurovascular injury, allowing enough space to safely treat parasellar lesions. The type, size, and location of the lesion, as well as the surgeon’s experience, should always be considered for surgical planning.
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Avraham E, Smolikov A, Smolyakov R, Azriel A, Sufaro Y, Kaisman-Elbaz T, Zlatin G, Melamed I. Minimally Invasive Subtemporal Intradural Approach for Penetrating Orbitocranial Injury by Wooden Foreign Body Into the Lateral Wall of the Cavernous Sinus. Front Surg 2020; 7:533567. [PMID: 33195384 PMCID: PMC7536401 DOI: 10.3389/fsurg.2020.533567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 08/17/2020] [Indexed: 11/26/2022] Open
Abstract
Non-missile transorbital penetrating head injuries are relatively rare, though potentially fatal injuries. Trajectory for intracranial entrance is typically via the orbital roof, the superior orbital fissure (SOF), or the optic canal. Non-metallic intracranial penetrating injuries are even scarcer and may pose unusual diagnostic and surgical challenges. Here we present and discuss a unique case of a penetrating injury by a wooden foreign body (FB) which entered and expanded the inter-dural space of the lateral cavernous sinus (CS) sinus wall without intracavernous or intradural involvement. The patient was a 71 year-old male who fell face-down and sustained a penetrating transorbital injury by a dry twig fragment, which passed through the SOF and into the interdural space of lateral wall of the ipsilateral CS. The patient was fully conscious (GCS15) at presentation but had severe ocular injury (complete ophthalmoplegia and blindness of the injured eye). The wooden FB was successfully removed via a minimally invasive subtemporal intradural approach with no apparent immediate or long-term complications. We emphasize the unusual diagnostic and surgical challenges related to this kind of rare injuries as reflected by the decision-making considerations taken in the presented case.
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Affiliation(s)
- Elad Avraham
- Department of Neurosurgery, Soroka University Medical Center, Beersheba, Israel
| | - Alexander Smolikov
- Department of Radiology, Soroka University Medical Center, Beersheba, Israel
| | - Rozalia Smolyakov
- Infectious Diseases Unit, Soroka University Medical Center, Beersheba, Israel
| | - Amit Azriel
- Department of Neurosurgery, Soroka University Medical Center, Beersheba, Israel
| | - Yuval Sufaro
- Department of Neurosurgery, Soroka University Medical Center, Beersheba, Israel
| | | | - Gregory Zlatin
- Department of Otorhinolaryngology (ENT), Soroka University Medical Center, Beersheba, Israel
| | - Israel Melamed
- Department of Neurosurgery, Soroka University Medical Center, Beersheba, Israel
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Xiao L, Xie S, Tang B, Hu J, Hong T. Endoscopic endonasal anterior clinoidectomy: surgical anatomy, technique nuance, and case series. J Neurosurg 2020; 133:451-461. [PMID: 31277066 DOI: 10.3171/2019.4.jns183213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 04/08/2019] [Indexed: 11/06/2022]
Abstract
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.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.
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Cai Q, Guo Q, Zhang W, Ji B, Chen Z, Chen Q. Extradural anterior clinoidectomy and aneurysm clipping using transcranial neuroendoscopic approach: A case report. Medicine (Baltimore) 2019; 98:e15288. [PMID: 31027089 PMCID: PMC6831113 DOI: 10.1097/md.0000000000015288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Anterior clinoidectomy is an important technique for neurovascular and skull base surgery. Until now, extradural anterior clinoidectomies have been performed under a microscope in almost all clinical cases, with only one clinical case performed an extradural pathological anterior clinoid process resection using neuroendoscopy. Additionally, no normal ACP resections have been performed extradurally via neuroendoscopy, especially for aneurysms. We tried to perform extradural anterior clinoidectomies by neuroendoscopy. PATIENT CONCERNS A 63-year-old woman was admitted to hospital presented with sudden onset of headache without any accompanying neurological deficit. A computed tomography (CT) scan of the head revealed a subarachnoid hemorrhage, which was positioned mainly in the left slyvian fissure and interpeduncular and basilar cisterns. DIAGNOSES 1. Left side posterior communicating artery aneurysm; 2. subarachnoid hemorrhage. INTERVENTIONS Extradural anterior clinoidectomy and aneurysm clipping were performed using transcranial neuroendoscopic approaches. OUTCOMES The patient recovered well after the procedure, and the post-operative image view revealed that the ACP had been removed and that the clip was located just at the ACP area. LESSONS This case provided the first evidence that extradural anterior clinoidectomy could be performed by transcranial neuroendoscopic approach.
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