-Spellman J , Heros RC : A pneumatized anterior clinoid mimicking an aneurysm on MR imaging. Report of two cases . J Neurosurg 71 : 128 – 132 , 1989 10.3171/jns.1989.71.1.0128 13 Hoh BL , Carter BS , Budzik RF , Putman CM , Ogilvy CS : Results after surgical and endovascular treatment of paraclinoid aneurysms by a combined neurovascular team . Neurosurgery 48 : 78 – 90 , 2001 14 Huynh-Le P , Natori Y , Sasaki T : Surgical anatomy of the anterior clinoid process . J Clin Neurosci 11 : 283 – 287 , 2004 10.1016/j.jocn.2003
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Takeshi Mikami, Yoshihiro Minamida, Izumi Koyanagi, Takeo Baba, and Kiyohiro Houkin
Stephen Lawrence Nutik
R emoval of the anterior clinoid process is of well-recognized value in the treatment of proximal internal carotid artery aneurysms. Many authors have described techniques of removal but seldom refer to the relevant anatomy of the region or state how much exposure can be expected. 4, 5, 8, 10, 16, 25, 29 This paper describes the pertinent anatomy, the maximum carotid exposure expected, and some complications that can result from removal of the anterior clinoid process. Clinical Material and Methods Anatomical Observations Tissue blocks containing
Hiroyuki Kinouchi, Katsuya Futawatari, Kazuo Mizoi, Naoki Higashiyama, Hisashi Kojima, and Tetsuya Sakamoto
, 23, 27 In addition to the ipsilateral and midline approaches to aneurysms, 17, 24 the contralateral approach has also been undertaken because lesions arising from the medial wall of the ICA can be visualized directly without retracting the optic nerve and/or without removing the anterior clinoid process. 1, 4–6, 9, 14, 19, 20, 26, 27 Nevertheless, the contralateral approach has the disadvantage that proximal control of the ICA is relatively difficult compared with that during the ipsilateral approach. 4 Preliminary experience with the use of endoscopic
Ahmad Pour-Rashidi, Payam Asem, Kazem Abbasioun, and Abbas Amirjamshidi
LHC tumors mostly involve the flat bones, and more than 50% occur in the skull, mandible, spine, ribs, and pelvis. Skin, pituitary gland, brain, lung, liver, spleen, and gastrointestinal tract are less common tumor locations. 1 EG can be differentiated from other infections and tumors by histology. 1–4 To the best of our knowledge, no similar case of surgically treated, symptomatic EG confined to the anterior clinoid process (ACP) has been reported previously. We reviewed the relevant literature regarding clinical, imaging, and best treatment options for such a
Sameer Deshmukh and Franco Demonte
I nflammatory mucoceles, which are cystic masses of mucoid secretions lined by respiratory epithelium, can develop in the paranasal sinuses secondary to both osteum obstruction and sinus inflammation. 1–3 In certain individuals, the anterior clinoid processes may become pneumatized during the development of the skull base, making these structures susceptible to mucocele formation. Mucoceles and the resulting inflammation in the anterior clinoid process can cause visual dysfunction due to compression or inflammation of the optic nerve. A reduction in the
Felix Umansky, Alberto Valarezo, and Josef Elidan
, the brains were carefully removed to fully expose the skull base. Each head was placed in a Sugita head holder, turned 45° from the side of dissection, and extended slightly to simulate the surgical position. The main anatomical landmarks were identified; namely, the optic nerve, supraclinoid internal carotid artery (ICA), anterior and posterior clinoid processes, petroclinoid folds, and the third and fourth cranial nerves. The optic canal was then unroofed and the anterior clinoid process was removed to completely expose the superior and lateral walls of the
Stephen L. Nutik
the dorsum sellae are removed after exposing them via the cavernous sinus. A preliminary step in the transcavernous procedure is the removal of the anterior clinoid process, which Dolenc, et al., describe as an extradural modification of the standard pterional craniotomy. However, the same transcavernous exposure can be readily obtained using a completely intradural procedure following a standard pterional craniotomy. The following is a description of this intradural technique and a discussion of its advantages over the partially extradural approach described by
Lateral orbital wall approach to the cavernous sinus
Laboratory investigation
Tamer Altay, Bhupendra C. K. Patel, and William T. Couldwell
of the lateral orbital rim (B) , and removal of the lateral orbital rim and anterior lateral orbital wall (C) . Note the gentle retraction of the temporalis muscle and the orbital structures. Once the superior orbital fissure is reached, it is opened wide and its inferior edge, which constitutes part of the lateral orbital wall, is removed. The initial craniocaudal borders are the base of the middle fossa inferiorly and the lesser sphenoid wing and the anterior clinoid process superiorly. A dissection plane is created between the dura of the temporal lobe and
Matthew J. Zdilla
A natomical variations in the sphenoid may complicate operative procedures and increase the likelihood of adverse surgical events. Such a noteworthy variation is that of the caroticoclinoid foramen (of Monro) (CCF), a foramen formed by an ossified caroticoclinoid ligament between the anterior and middle clinoid processes. 18 , 25 , 26 The CCF has been categorized as “complete,” “contact,” “almost complete,” “kissing-clinoids,” “incomplete,” or “partial” based on the extent of ligamentous ossification. 5 , 9–11 , 21 When present, the CCF encompasses the internal
Hiroyuki Kinouchi, Kazuo Mizoi, Yoshihide Nagamine, Noritaka Yanagida, Shigeki Mikawa, Akira Suzuki, Toshio Sasajima, and Takashi Yoshimoto
T he portion of the proximal intradural ICA adjacent to the anterior clinoid process is called the paraclinoid segment. 12 Aneurysms of the paraclinoid segment are usually located in the intradural space and their rupture will cause SAH. Some paraclinoid aneurysms, however, are considered unclippable or surgical treatment results in disastrous outcomes due to the location of the aneurysm. 13, 18 Therefore, the classification of these aneurysms according to the origin of their necks or their relationships with anatomical landmarks is particularly important to
