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Published on: August 11, 2015
Endoscopic extradural anterior clinoidectomy via supraorbital keyhole: a cadaveric study
Fuminari Komatsu1, Mika Komatsu, Tooru Inoue
1Department of Neurosurgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Johnan-ku, Fukuoka, Japan. fkomatsu@fukuoka-u.ac.jp
Background:
Anterior clinoidectomy is an essential preliminary step for parasellar and pericavernous sinus surgery. Endoscopy is a widely accepted modality for neurosurgical strategies and is becoming more important in treating conditions involving the cranial base.
Objective:
To determine the feasibility of endoscopic extradural anterior clinoidectomy via the supraorbital keyhole.
Methods:
Eight fresh cadaver heads were studied using 4-mm, 0- and 30-degree rigid endoscopes to perform endoscopic extradural anterior clinoidectomy. We also evaluated a bony landmark for this technique in 36 dry craniums.
Results:
An endoscope was introduced into the extradural space created via a supraorbital keyhole craniotomy. The periorbita and the duplication of the dura extending to the temporal lobe dura and periorbita were exposed by drilling. Anterior clinoidectomy proceeded using a diamond drill under endoscopic visualization without a dural incision. A submerged view with continuous irrigation through an endoscopic sheath maintained clear visibility while drilling. A small bony eminence at the transition between the sphenoid ridge and the anterior clinoid process, which is an anatomic landmark for endoscopic extradural anterior clinoidectomy, was identified in 57.4% of 36 adult dry craniums.
Conclusion:
The endoscopic extradural procedure can accomplish reliable anterior clinoidectomy under superb endoscopic visualization. This method would be applicable to parasellar and cavernous sinus surgery combined with keyhole or conventional craniotomy.
