Selective extradural anterior clinoidectomy for supra- and parasellar processes. Technical note

Area of Science:

• Neurosurgery
• Skull Base Surgery
• Cranial Surgery

Background:

• The anterior clinoid process (ACP) obstructs surgical access to the supra- and parasellar regions.
• Tumors and aneurysms in these areas often require extensive brain retraction or limited exposure.
• Radical removal of ACP can improve operative visualization and reduce brain retraction.

Purpose of the Study:

• To evaluate the efficacy and safety of anterior clinoidectomy for accessing tumors and aneurysms.
• To compare extradural and intradural approaches for ACP removal.
• To assess surgical outcomes and complications associated with anterior clinoidectomy.

Main Methods:

• Anterior clinoidectomy was performed on 40 patients over 3 years for aneurysms or tumors.
• Procedures included extradural removal (31 cases) and intradural removal (9 cases).
• Patient diagnoses included internal carotid artery aneurysms, basilar artery aneurysms, pituitary tumors, craniopharyngiomas, and sphenoid ridge meningiomas.

Main Results:

• Satisfactory outcomes were achieved in all patients, with one exception experiencing infarction after basilar tip aneurysm clipping.
• Postoperative visual deficits occurred in 3 patients after extradural clinoidectomy.
• One patient developed cerebrospinal fluid rhinorrhea requiring reoperation.

Conclusions:

• Anterior clinoidectomy offers wide operative exposure for supra- and parasellar lesions, reducing the need for brain retraction.
• The extradural technique is generally easier, faster, and provides better exposure than the intradural approach.
• Anterior clinoidectomy is a valuable and routinely applicable technique for managing lesions in these critical neurosurgical regions.