Anterior clinoidectomy
Facilitates access to parasellar and suprasellar regions.
Variations
- Extradural Anterior Clinoidectomy - (for short/normal-sized clinoid or distant aneurysms)
- Intradural Anterior Clinoidectomy - (preferred for aneurysms adjacent to clinoid or long/fused clinoid)
Techniques for Extradural Anterior Clinoidectomy
- Optic canal unroofing w/ diamond
- Peel dura from ACP.
- Use high-speed drill for coring out ACP
- Remove optic strut
Techniques for Intradural Anterior Clinoidectomy
Surgical Considerations
- Check for sphenoid or ethmoidal sinus extensions into optic strut/ACP.
- Seal any openings with temporalis fascia, fat, or hydroxyapatite bone cement; aim for watertight dural closure.
- If frontal sinus opened, prevent CSF leak by removing mucosa.