Extradural and Intradural Anterior Clinoidectomy: Technical Nuances and Video Illustration

An anterior clinoidectomy is an important skull-base technique to have in the armamentarium when managing pathology of the paraclinoid region. Drilling the anterior clinoid (AC) provides access to the clinoidal internal carotid artery and early decompression of the optic nerve. This technique is essential in the management of central skull base tumors and aneurysms, especially from the opticocarotid region. The intricate neurovascular anatomy associated with the AC can be difficult to master. There are 2 main techniques for drilling the AC, intradural and extradural, although hybrid techniques have been described. The goal of this article was to provide an up-to-date technical report on performing an anterior clinoidectomy supplemented by high-quality original dissections and a 4K 2-dimensional video as a resource for trainees and junior neurosurgeons.