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Published on: August 11, 2015
Enhanced exposure of carotico-oculomotor triangle following extradural anterior clinoidectomy: a comparative
Burak Sade1, Chang Y Kweon, James J Evans
1Brain Tumor Institute, Department of Neurosurgery, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Objective:
To quantify and compare the carotico-oculomotor triangle (COT) area before and after extradural anterior clinoidectomy (AC).
Methods:
Ten cadaveric heads were dissected bilaterally. Before and after an extradural AC, the following points were measured: (1) the internal carotid artery (ICA) bifurcation to the tip of the anterior clinoid process (ACP) (A) and to the distal dural ring (A'), (2) the ICA bifurcation to the point where the oculomotor nerve becomes obscured by the tentorial fold (B) and to the porus oculomotoris after incision of the tentorial fold (B'), and (3) the tip of the ACP to the point where the oculomotor nerve becomes obscured by the tentorial incisura (C) and from the distal dural ring to the porus oculomotoris (C'). The area of the COT was calculated before and after AC (DeltaABC and DeltaA'B'C', respectively).
Results:
The mean values were as follows: A: 9.15 +/- 0.93 mm, A': 13.45 +/- 0.82 mm; B: 7.80 +/- 1.24 mm, B': 9.90 +/- 1.21 mm; C: 7.15 +/- 0.99 mm, C': 9.3 +/- 1.26 mm; DeltaABC: 26.26 +/- 6.05 mm, DeltaA'B'C': 45.06 +/- 8.92 mm.
Conclusions:
Extradural AC enhances the exposure of the COT almost twofold. This increased exposure can be of significant help during resection of lesions of the parasellar and basilar apex regions.