Carotico-Clinoid Ligament Ossification: Unproven Risk to Internal Carotid Artery Flow

The ossification of carotico-clinoid ligament (CCL) has been claimed to be a risk factor for blood flow compromise in the corresponding internal carotid artery (ICA). Despite its seriousness, this concept has not been distinctly examined in the literature. A systematic review following the PRISMA-statement was conducted. Searches were performed in PubMed, MEDLINE, Cochrane Library, and Neurosurgery Atlas GPT for the terms "carotico-clinoid ligament and foramen" in various formats. The clinical role of these structures (focusing on blood flow in ICA) was examined. A global survey targeting neuro-related doctors was conducted to capture the current perspectives of professionals in the field about these structures regarding compromising blood supply to ICA. A bibliometric analysis using Vos viewer was performed to visualize the status of these structures in literature. 59 publications were identified from 1935 through 2024 in the PubMed, MEDLINE, and Neurosurgery Atlas GPT databases. The majority of these publications came out in the last 12 years. No case reports supported the claim that ossified CCL could compromise the ICA and brain blood supply. There were 63 respondents from 14 different countries who addressed the questionnaire. Responses from five neuro-related specialties were analyzed, but neurologists (zero respondents). No one reported personal experience or awareness that CCF could compromise blood flow to the ICA. Vos viewer analysis showed that endoscopic neurosurgical approaches enhanced the understanding of CCL in the last decade. No evidence was found to support that the ossified CCL could compromise the ICA or brain blood supply.