The caroticoclinoid foramen in fetal and infantile orbitosphenoid, presphenoid, and sphenoid bones: developmental and neurosurgical considerations

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OBJECTIVE

The presence of a caroticoclinoid foramen may increase the likelihood of adverse neurosurgical events. Despite the clinical importance of the caroticoclinoid foramen, its study has been mostly limited to adult populations. Therefore, the object of this study was to describe the prevalence, morphology, and development of the caroticoclinoid foramen among varied sexes and races in early life.

METHODS

The study analyzed caroticoclinoid foramina in dry orbitosphenoid, presphenoid, and sphenoid bones from a population of 101 fetal and infantile crania of varied sex and race.

RESULTS

A caroticoclinoid foramen, whether complete, near complete, or partial, was found in 36 of 199 sides (18.1%). Of the 98 crania with bilaterally intact sides, 21 (21.4%) had the presence of at least one caroticoclinoid foramen. Caroticoclinoid foramina were found unilaterally and bilaterally, in both female and male crania (9/41, 22.0%; 12/57, 21.1%, respectively) and, likewise, in crania of both black and white races (9/54, 16.7%; 12/44, 27.3%, respectively). Caroticoclinoid foramina were formed from cornuate bony projections from the anterior clinoid process, middle clinoid process, or both anterior and middle clinoid processes. Caroticoclinoid foramina were also found in isolated orbitosphenoid bones from individuals as young as 4 months’ fetal age.

CONCLUSIONS

The caroticoclinoid foramen occurs in approximately one of every 5 sides and in one in every 5 individuals of perinatal age and should, therefore, be considered a common finding in both fetuses and infants. It is common in both females and males as well as in both black and white races, alike. Furthermore, the caroticoclinoid foramen can be found in individuals as young as 4 months of fetal age. Failure to anticipate the presence of a caroticoclinoid foramen will place important neurovascular structures, including the internal carotid artery, at risk of injury. Neurosurgeons should, therefore, anticipate the caroticoclinoid foramen even in their youngest patients.

ABBREVIATIONS CCF = caroticoclinoid foramen; ICA = internal carotid artery.

Article Information

Correspondence Matthew J. Zdilla: West Liberty University, West Liberty, WV. mzdilla@westliberty.edu.

INCLUDE WHEN CITING Published online December 14, 2018; DOI: 10.3171/2018.9.PEDS18481.

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

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Superior view of a sphenoid bone from an 8-month-old black female fetus. A complete CCF is found on the left, and a partial CCF, formed by a cornuate bony projection from the anterior clinoid process, is found on the right. Figure is available in color online only.

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    Superior view of the left- and right-sided orbitosphenoid bones from a 6-month-old white male fetus. Near-complete CCFs are seen bilaterally. The posterior and posterolateral boundaries of the near-complete foramina are formed by bony extensions from the anterior clinoid processes found bilaterally. Figure is available in color online only.

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    Superior view of the sphenoid bone from a newborn white male infant. Partial CCFs are seen bilaterally. In this case, extensions from the anterior clinoid processes are forming the posterolateral boundaries of the incomplete foramina, and bony projections arising from the presphenoid region of the sphenoid (i.e., the middle clinoid processes) are extending posterolaterally to form the posteromedial boundaries of the incomplete foramina. The bony processes arising from the middle clinoid processes are asymmetrical—the left-sided projection is marked, while the right-sided projection is relatively small. Figure is available in color online only.

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    Heat map relating the relative frequency (expressed as a percentage) of CCF types to age in fetal and infant populations.

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