Evaluation of posterior clinoid process pneumatization by multidetector computed tomography

Area of Science:

• Anatomy and Radiology
• Neurosurgery
• Medical Imaging

Background:

• Pneumatization of the posterior clinoid process (PCP) is an anatomical variation.
• Understanding PCP pneumatization is crucial for surgical planning involving the skull base and neurovascular structures.

Purpose of the Study:

• To investigate the prevalence, types, and ratios of PCP pneumatization using paranasal sinus multidetector computed tomography (MDCT).
• To analyze demographic differences (age, sex) in PCP pneumatization.
• To correlate PCP pneumatization types with surgical risks, particularly regarding cerebrospinal fluid (CSF) fistulas.

Main Methods:

• Retrospective analysis of paranasal sinus MDCT scans from 541 subjects (15-65 years old).
• Evaluation of anterior clinoid process and PCP pneumatization, classifying types (I, II, III).
• Statistical analysis of pneumatization prevalence and types based on sex and age.

Main Results:

• PCP pneumatization detected in 20.7% of males and 11.5% of females, with higher prevalence in males.
• Type I pneumatization was the most common (61.2% overall), observed in 70.4% of right-sided, 65.2% of left-sided, and 50.0% of bilateral cases.
• Pneumatization was more frequent in younger subjects and decreased with age, possibly due to age-related sclerosis.

Conclusions:

• Male sex and younger age are associated with higher rates of PCP pneumatization.
• Type I pneumatization is predominant, while Type III pneumatization warrants caution during posterior clinoidectomy to avoid CSF fistulas.
• Preoperative radiological assessment of PCP is vital for safe surgical planning around the cavernous sinus and basilar apex.