Modified intradural anterior clinoidectomy to protect the paraclinoid neurovascular structures: A technical note

Abstract

Objective: Anterior clinoidectomy is effective in creating an adequate working field during surgery for paraclinoid lesions. However, intradural anterior clinoidectomy (iAC) is associated with intraoperative injury to the paraclinoid neurovasular structures because they are exposed in the surgical field. Here we introduce our modified technique in removing the anterior clinoid process (ACP) to compensate the drawbacks of iAC. Methods: This technical case report is presented by demonstration of cadaver dissection and surgical video. Results: Cadaver dissection study demonstrates the step-by-step procedure. Our technique primarily aims at sectioning of the dura adjacent to the ACP to obtain both intradural and extradural operative fields. With this technique, the ACP can be safely removed without injuring the neurovascular structure, such as the optic nerve and internal carotid artery. As an example of its clinical application, we present a case of a 67-year-old woman with anterior clinoid meningioma and visual deficits. The ACP was safely removed using a high-speed drill without injuring the neurovascular structures. Gross total resection was achieved. Her vision returned to normal postoperatively. Conclusions: Using our modified technique, the widely reflected dura covers the critical neurovascular structure during the skull base drilling. Therefore, this technique compensates the drawbacks inherent to iAC.

Keywords

• Anterior clinoidectomy
• Complication
• Skull base surgery