Anterior Clinoidectomy for Large IC-PC Aneurysms: Indication, Method, and Pitfalls

DOI 1 Citations Open Access
  • KUSUMI Mari
    Department of Neurosurgery, Kitasato University School of Medicine
  • FUKUSHIMA Takanori
    Division of Neurosurgery, Duke University Medical Center
  • OKA Hidehiro
    Department of Neurosurgery, Kitasato University School of Medicine
  • SATO Sumito
    Department of Neurosurgery, Kitasato University School of Medicine
  • KUMABE Toshihiro
    Department of Neurosurgery, Kitasato University School of Medicine

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Other Title
  • IC-PC大型動脈瘤に対する前床突起切除
  • ─適応，方法，注意点─

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IC-PC aneurysms are common. For complete and safe clipping, some require anterior clinoidectomy. When the aneurysm is large or the distance between the anterior clinoid process and the aneurysmal neck is short, an anterior clinoidectomy is needed. We describe our method for addressing such aneurysms step-by-step, cite the pitfalls of extradural anterior clinoidectomy and review the anatomy. Our technique involves (1) elevation of the dura propria from the true cavernous sinus membrane on the superior orbital fissure and foramen rotundum, (2) unroofing of the optic canal, (3) drilling of the interior of the anterior clinoid and detachment from the optic strut under continuous irrigation, and (4) dissection of the anterior clinoid process from the carotico-oculomotor membrane and subsequent removal. It is important to create a wide operating field and to protect the optic- and oculomotor nerve. IC-PC aneurysms do not require complete resection of the optic strut and optic canal. Then the distal dural ring is opened without cutting the ring into the posterior cavernous sinus. <br> We recommend extradural anterior clinoidectomy as an advanced technical method to address complex IC-PC aneurysms. It is a safe, minimal and simple technique that can be used to train neurosurgeons in the skull base technique, if the anatomy is understood and the procedure is carried out step-by-step. <br>

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