Endoscopic endonasal anterior clinoidectomy: surgical anatomy, technique nuance, and case series

Limin Xiao MD, Shenhao Xie MM, Bin Tang MD, Jialing Hu BMed and Tao Hong MD
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  • Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
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Advances in endoscopic technique allow for resection of the anterior clinoid process (ACP) via an endoscopic endonasal approach. The authors discuss the endoscopic endonasal anterior clinoidectomy (EEAC) and demonstrate the relevant surgical anatomy and technical nuances. The approach was simulated in 6 cadaveric heads. From a technical point of view, the lateral optic carotid recess was used as the landmark in the proposed technique. The superomedial, superolateral, and inferior vertices of this recess are the main operative points. The EEAC approach was achieved by disconnecting the ACP tip from the base by drilling the 3 vertices. The proposed approach was successfully performed in all cadaveric specimens. Then, in a case series involving 6 patients in whom the EEAC approach was used, there were no vascular injuries; 2 patients had postoperative oculomotor nerve palsy, which improved in one and resolved in the other by 1 month.

The EEAC approach for tumors and vascular lesions in the parasellar region is technically feasible. The surgical corridor is increased by ACP resection, although to a lesser extent than the transcranial anterior clinoidectomy. Based on the authors’ initial anatomical and surgical results, resection of the ACP via the endonasal endoscopic approach is a novel technique worth exploring in suitable cases.

ABBREVIATIONS ACP = anterior clinoid process; EEAC = endoscopic endonasal anterior clinoidectomy; ICA = internal carotid artery; LOCR = lateral opticocarotid recess.

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Contributor Notes

Correspondence Tao Hong: The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, People’s Republic of China. ht2000@vip.sina.com.

INCLUDE WHEN CITING Published online July 5, 2019; DOI: 10.3171/2019.4.JNS183213.

L.X. and S.X. share first authorship of this work.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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