Tailored anterior clinoidectomy through the lateral supraorbital approach: experience with 82 consecutive patients

To demonstrate that anterior clinoidectomy is possible through the lateral supraorbital (LSO) approach, and that extent of the clinoidectomy is tailored according to the lesion. We reviewed our recent experience on patients with vascular and tumor who underwent anterior clinoidectomy through the LSO approach.

Between June 2007 and January 2011, 82 patients with neoplastic and vascular lesions underwent anterior clinoidectomy by the senior author (J.H.) with the LSO approach. We retrospectively analyzed the surgical videos and the microsurgical techniques of anterior clinoidectomy.

Forty-five patients were treated for aneurysms, 35 patients for intraorbital, parasellar and suprasellar tumors, and 2 patients presented with carotid-cavernous fistula. Intradural anterior clinoidectomy was performed in 67 patients (82%); in 15 patients (18%) extradural anterior clinoidectomy was used. A minimal removal of the anterior clinoid process (ACP) was performed in 5 patients, in 8 patients a partial clinoidectomy was performed, in 18 patients a subtotal removal of the ACP was needed, and in 51 patients, the entire ACP was removed. There was no operation-related mortality in the series.

A tailored anterior clinoidectomy is useful and can be performed through the LSO approach. Intradural visualization of the internal carotid artery and optic nerve is mandatory for the exact anatomic orientation and safe anterior clinoidectomy. We recommend intradural anterior clinoidectomy for all vascular and most neoplastic lesions.