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Limin Xiao, Shenhao Xie, Bin Tang, Jialing Hu and Tao Hong

removed along the glabella–external occipital protuberance line, with special attention taken not to impair the bilateral optical nerve, chiasm, and ACP. Endoscopic endonasal exposure of the sellar region was performed as previously described. 9 , 10 After exposure of the lateral opticocarotid recess (LOCR), the EEACs were performed as shown in Fig. 1 . After each step of the procedure, observations were made under both endoscope and microscope. The endoscopic endonasal anatomical dissections and measurement were performed using 0° (4-mm-diameter, 18-cm-long) rod

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Ali Tayebi Meybodi, Leandro Borba Moreira, Andrew S. Little, Michael T. Lawton and Mark C. Preul

. D: Proximal control obtained on the extracavernous paraclival ICA. E: Exposure of the clinoidal ICA using 3 consecutive dural cuts ( black arrows ) starting from the caroticosellar point reaching the medial opticocarotid point, and then continuing inferior to the DDR to reach the medial vertex of the lateral opticocarotid recess, and finally descending on the lateral aspect of the clinoidal ICA. F: Proximal control on the clinoidal ICA. G: Dural incision to expose the supraclinoid ICA. The dural incision could be started either on the lateral tubercular

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Matteo de Notaris, Domenico Solari, Luigi M. Cavallo, Alfonso Iodice D'Enza, Joaquim Enseñat, Joan Berenguer, Enrique Ferrer, Alberto Prats-Galino and Paolo Cappabianca

different as observed from a transcranial (superior) perspective. As a matter of fact, as regards their appearance from a different standpoint, these structures could be differently named. For instance, the root representing the floor of the optic canal, extending from the floor of the anterior clinoidal process to the sphenoid body to divide the optic canal from the superior orbital fissure and known as the “optic strut,” 34 , 35 corresponds, from an inferior perspective, to the lateral opticocarotid recess. 2 , 5 , 21 , 23 Moreover, other structures, such as the

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Ali Tayebi Meybodi, Leandro Borba Moreira, Michael T. Lawton, Jennifer M. Eschbacher, Evgenii G. Belykh, Michelle M. Felicella and Mark C. Preul

approximate location of the DDR was marked by a line connecting the medial vertex of the lateral opticocarotid recess and the medial opticocarotid recess located at the lateral end of the tubercular recess ( Fig. 1A ). Next, the dural incision was continued on the medial aspect of the optic canal ( Fig. 1B ) and then extended to the region of the orbital apex to open the annulus of Zinn, finally reaching the periorbita of the medial orbital wall ( Fig. 1C ). The OphA was found at its origin from the intradural ICA, and its course was followed anteriorly up to the level of

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Ricky Madhok, Daniel M. Prevedello, Paul Gardner, Ricardo L. Carrau, Carl H. Snyderman and Amin B. Kassam

—both internal carotid arteries, the optic nerves, the medial and lateral opticocarotid recesses, and the clival recess—were identified ( Fig. 1 ). For purely sellar tumors, the sellar face was drilled “eggshell thin” and removed with a Kerrison rongeur until the “blue” of the cavernous sinus was identified laterally, and the superior and inferior intercavernous sinuses were identified superiorly and inferiorly, respectively. Most importantly, the floor of the sella turcica was carefully removed using the same technique. Removing the entire anterior face of the sphenoid sinus

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Ricardo L. L. Dolci, Leo F. S. Ditzel Filho, Carlos R. Goulart, Smita Upadhyay, Lamia Buohliqah, Paulo R. Lazarini, Daniel M. Prevedello and Ricardo L. Carrau

the left side, the dura was kept intact, and the lateral opticocarotid recess is visible superiorly; this is a critical landmark to recognize between the optic nerve and ICA; inferiorly, from lateral to medial, it is visualized by the impression of the maxillary strut and the maxillary nerve behind the dura. The portion of bone that was preserved in front of the QS, working like a shield to protect it, we named the “QS strut.” B: The QS strut was removed. C: With a 30° endoscope, the entire course of the vidian nerve can be seen along the vidian canal. It is

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Maria Koutourousiou, Juan C. Fernandez-Miranda, S. Tonya Stefko, Eric W. Wang, Carl H. Snyderman and Paul A. Gardner

canal in every case and involved both canals in 4 patients. Interestingly, 6 of the 20 patients with optic canal involvement had small unilateral tuberculum sellae meningiomas ( Fig. 1 ), with early vision loss due to canal involvement. Optic canal involvement was confirmed intraoperatively in every case and defined as extension of the tumor beyond the anteriormost aspect of the optic strut (or lateral opticocarotid recess) in all 20 patients. F ig . 1. Unilateral tuberculum sellae meningioma with optic canal involvement. Upper: Preoperative coronal and

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Charles Kulwin, Theodore H. Schwartz and Aaron A. Cohen-Gadol

certain coronal planes, it is possible to see and remove tumor lateral to these limits because of the endoscope's fish-eye field of view, the existence of angled endoscopes, and corresponding angled instrumentation. There are no absolute limitations to lesion size for endoscopic endonasal surgery; however, lesions smaller than 4 cm are considered ideal. Although the lateral limits of the corridor are formed first by the lamina papyracea, then the carotid siphon in the cavernous sinus, then the lateral opticocarotid recess around the sella and the carotid bifurcation in

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Amir R. Dehdashti and Fred Gentili

completion of the wide sphenoidotomy, the following anatomical structures in the sphenoid should be seen: clival and sellar carotid prominence, medial and lateral opticocarotid recess, planum, and clivus. A micro-Doppler probe is used to identify and confirm the trajectory of both carotid arteries. The dural opening is made from the medial cavernous sinus wall and from the superior intercavernous sinus to the clivus. With the binostril bimanual technique, tumor is removed using the same principles as with the microscopic technique. In cases of focal compression toward the

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Ali Tayebi Meybodi, Michael T. Lawton, Sonia Yousef, Xiaoming Guo, Jose Juan González Sánchez, Halima Tabani, Sergio García, Jan-Karl Burkhardt and Arnau Benet

opticocarotid recess were exposed. In addition, the reliability of line B as a landmark for localizing the OS was assessed in the simulated surgical setting. Clinical Case Series To assess the clinical safety and feasibility of the proposed technique, we performed the ACTH technique on a series of 6 patients requiring anterior clinoidectomy as part of the surgical strategy to address their intracranial pathology. Results The proposed 2-step hybrid technique for removal of the ACP was safely performed in all specimens by using line B as a landmark to localize the OS. In dry