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Updated: May 20, 2026
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Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
Endoscopic endonasal middle clinoidectomy: anatomic, radiological, and technical note.
Juan C Fernandez-Miranda1, Matthew Tormenti, Fernando Latorre
1Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA. fernandezmirandajc@upmc.edu
Neurosurgery
|July 19, 2012
Summary
Understanding the middle clinoid and caroticoclinoidal ring is crucial for planning endonasal skull base surgery. This study details their anatomy and safe removal techniques for improved surgical access.
Area of Science:
- Neurosurgery
- Skull Base Anatomy
- Endoscopic Surgery
Background:
- The middle clinoid is a bony landmark on the sphenoid bone, near the sella turcica.
- Its anatomical variations can impact surgical approaches to the skull base.
Purpose of the Study:
- To delineate the radiological and surgical anatomy of the middle clinoid.
- To describe technical nuances for endoscopic endonasal removal of the middle clinoid.
Main Methods:
- Analysis of 100 head CT-angiograms and 50 anatomical specimens.
- Categorization of middle clinoid morphology and caroticoclinoidal ring presence.
- Study of surgical anatomy using silicon-injected specimens and intraoperative observations.
Main Results:
- Middle clinoid identified in 60% of CT scans; caroticoclinoidal ring in 20%.
- Middle clinoid location: transition zone of internal carotid artery (ICA), covering cavernous sinus roof.
- Endonasal removal facilitates access to the parasellar region, sequentially exposing key structures.
Conclusions:
- Preoperative identification of the middle clinoid and caroticoclinoidal ring is essential.
- This recognition aids surgical planning for endonasal skull base procedures.
- Safe middle clinoidectomy can be performed, even with a caroticoclinoidal ring present.
