Neurosurgical Review

, Volume 33, Issue 3, pp 367–374 | Cite as

Pneumatization degree of the anterior clinoid process: a new classification

  • Bashar Abuzayed
  • Necmettin Tanriover
  • Huseyin Biceroglu
  • Odhan Yuksel
  • Ozlem Tanriover
  • Sait Albayram
  • Ziya Akar
Original Article

Abstract

The objective of this study is to determine the incidence and degree of anterior clinoid process pneumatization, in addition highlighting to their clinical significance. Multidetector-row CT scans of the skull base were reviewed in 648 subjects between 2007 and 2008. The presence of pneumatized anterior clinoid process and its degree were studied and documented. These datas were istatistically analyzed. Pneumatization of the ACP was found in 62 of 648 patients (9.6%) including 32 (51.6%) men and 30 (48.4%) women. The age of these patients ranged from 21 to 82 years (mean, 41 ± 15.7 years). Pneumatization of the ACP occurred only on the left side in 14 cases (22.6%), only on the right side in 11 cases (17.7%), and bilaterally in 37 patients (59.7%). ACP pneumatization Type I, in which less than 50% of the ACP is pneumatized, was found in 47 of 124 sides (38%), Type II, in which more than 50% but not totally pneumatized ACP, was found in 28 of 124 sides (22.6%), and Type III, in which the ACP is totally pneumatized, was found in 22 of 124 sides (17.7%). The incidence of Type I in the general population was 6.6%, Type II was 3.5%, and Type III was 2.5%. Radiologically recognizing the degree of ACP pneumatization is important in decreasing the incidence of surgical complications during anterior clinoidectomy. Proper intraoperative management can be undertaken with special attention to the new classification.

Keywords

Anterior clinoid process Anterior clinoidectomy Computed tomography Pneumatization Surgical anatomy 

Notes

References

  1. 1.
    Abuzayed B, Kafadar AM, Oğuzoğlu SA, Canbaz B, Kaynar MY (2009) Duraplasty using autologous fascia lata reenforced by on-site pedicled muscle flap: technical note. J Craniofac Surg 20(2):435–438CrossRefPubMedGoogle Scholar
  2. 2.
    Abuzayed B, Tanriover N, Ozlen F, Gazioglu N, Ulu MO, Kafadar AM, Eraslan B, Akar Z (2009) Endoscopic endonasal transsphenoidal approach to the sellar region: results of endoscopic dissection on 30 cadavers. Turk Neurosurg 19(3):237–244PubMedGoogle Scholar
  3. 3.
    Arslan H, Aydinlioglu A, Bozkurt M, Egeli E (1999) Anatomic variations of the paranasal sinuses: CT examination for endoscopic sinus surgery. Auris Nasus Larynx 26:39–48CrossRefPubMedGoogle Scholar
  4. 4.
    Bolger WE, Butzin CA, Parsons DS (1991) Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope 101:56–64CrossRefPubMedGoogle Scholar
  5. 5.
    Chi JH, Sughrue M, Kunwar S, Lowton MT (2006) The “yo-yo” technique to prevent cerebrospinal fluid rhinorrhea after anterior clinoidectomy for proximal internal carotid artery aneurysms. Neurosurgery 59(Suppl 1):101–107Google Scholar
  6. 6.
    Citardi MJ, Gallivan RP, Batra PS, Maurer CR Jr, Rohlfing T, Roh HJ, Lanza DC (2004) Quantitative computer-aided computed tomography analysis of sphenoid sinus anatomical relationships. Am J Rhinol 18:173–178PubMedGoogle Scholar
  7. 7.
    Coscarella E, Baskaya MK, Morcos JJ (2003) An alternative extradural exposure to the anterior clinoid process: the superior orbital fissure as a surgical corridor. Neurosurgery 53:162–167CrossRefPubMedGoogle Scholar
  8. 8.
    DeLano MC, Fun FY, Zinreich SJ (1996) Relationship of the optic nerve to the posterior paranasal sinuses: a CT anatomic study. AJNR Am J Neuroradiol 17:669–675PubMedGoogle Scholar
  9. 9.
    Deshmukh S, De Monte F (2007) Anterior clinoidal mucocele causing optic neuropathy: resolution with nonsurgical therapy. J Neurosurg 106:1091–1093CrossRefPubMedGoogle Scholar
  10. 10.
    Dolenc V (1989) Anatomy and surgery of the cavernous sinus. Wien Springer, New YorkGoogle Scholar
  11. 11.
    Dolenc VV (1985) A combined epi- and subdural direct approach to carotid-ophthalmic artery aneurysms. J Neurosurg 62:667–672CrossRefPubMedGoogle Scholar
  12. 12.
    Dolenc VV (1999) A combined transorbital-transclinoid and transsylvian approach to carotid-ophthalmic aneurysms without retraction of the brain. Acta Neurochir Suppl 72:89–97PubMedGoogle Scholar
  13. 13.
    Gean AD, Pile-Spellman J, Heros RC (1989) A pneumatized anterior clinoid mimicking an aneurysm on MR imaging. Report of two cases. J Neurosurg 71:128–132CrossRefPubMedGoogle Scholar
  14. 14.
    Hoh BL, Carter BS, Budzik RF, Putman CM, Ogilvy CS (2001) Results after surgical and endovascular treatment of paraclinoid aneurysms by a combined neurovascular team. Neurosurgery 48:78–90CrossRefPubMedGoogle Scholar
  15. 15.
    Huynh-Le P, Natori Y, Sasaki T (2004) Surgical anatomy of the anterior clinoid process. J Clin Neurosci 11:283–287CrossRefPubMedGoogle Scholar
  16. 16.
    Inoue T, Rhoton AL, Theele D, Barry ME (1990) Surgical approaches to the cavernous sinus: a microsurgical study. Neurosurgery 26:903–932CrossRefPubMedGoogle Scholar
  17. 17.
    Kelley TF, Stankiewicz JA, Chow JM, Origitano TC, Shea J (1996) Endoscopic closure of postsurgical anterior cranial fossa cerebrospinal fluid leaks. Neurosurgery 39:743–746CrossRefPubMedGoogle Scholar
  18. 18.
    Knosp E, Müller G, Perneczky A (1988) The paraclinoid carotid artery: anatomical aspects of a microneurosurgical approach. Neurosurgery 22:896–901CrossRefPubMedGoogle Scholar
  19. 19.
    Kobayashi S, Kyoshima K (1989) Carotid cave aneurysms of the internal carotid artery. J Neurosurg 70:216–221CrossRefPubMedGoogle Scholar
  20. 20.
    Kondo S, Okada Y, Iseki H, Hori T, Takakura K, Kobayashi A, Nagata H (2000) Thermological study of drilling bone tissue with a high-speed drill. Neurosurgery 46:1162–1168CrossRefPubMedGoogle Scholar
  21. 21.
    Korosue K, Heros RC (1992) “Subclinoid” carotid aneurysm with erosion of the anterior clinoid process and fatal intraoperative rupture. Neurosurgery 31:356–360CrossRefPubMedGoogle Scholar
  22. 22.
    Liddell HG, Scott R (1889) An ıntermediate Greek-English Lexicon, founded upon the seventh edition of Liddell and Scott’s Greek-English Lexicon. Harper & Brothers, New YorkGoogle Scholar
  23. 23.
    Lim CC, Dillon WP, McDermott MW (1999) Mucocele involving the anterior clinoid process: MR and CT findings. AJNR Am J Neuroradiol 20:287–290PubMedGoogle Scholar
  24. 24.
    Mikami T, Minamida Y, Koyanagi I, Baba T, Houkin K (2007) Anatomical variations in pneumatization of the anterior clinoid process. J Neurosurg 106:170–174CrossRefPubMedGoogle Scholar
  25. 25.
    Nandapalan V, Watson ID, Swift AC (1996) Beta-2-transferrin and cerebrospinal fluid rhinorrhoea. Clin Otolaryngol Allied Sci 21:259–264CrossRefPubMedGoogle Scholar
  26. 26.
    Noguchi A, Balasingam V, Shiokawa Y, McMenomey SO, Delashaw JB Jr (2005) Extradural anterior clinoidectomy. Technical note. J Neurosurg 102:945–950CrossRefPubMedGoogle Scholar
  27. 27.
    Nutik SL (1988) Removal of the anterior clinoid process for exposure of the proximal intracranial carotid artery. J Neurosurg 69:529–534CrossRefPubMedGoogle Scholar
  28. 28.
    Phuong Huynh-Le P, Natori Y, Sasaki T (2004) Surgical anatomy of the anterior clinoid process. J Clin Neurosci 11(3):283–287CrossRefPubMedGoogle Scholar
  29. 29.
    Prepageran N, Subramaniam KN, Krishnan GG, Raman R (2004) Ocular presentation of sphenoid mucocele. Orbit 23:45–47CrossRefPubMedGoogle Scholar
  30. 30.
    Sapci T, Derin E, Almac S, Cumali R, Saydam B, Karavus M (2004) The relationship between the sphenoid and the posterior ethmoid sinuses and the optic nerves in Turkish patients. Rhinology 42:30–34PubMedGoogle Scholar
  31. 31.
    Senyuva C, Yucel A, Okur I, Cansiz H, Sanus Z (1996) Free rectus abdominis muscle flap for the treatment of complications after neurosurgical procedures. J Craniofac Surg 7:317–321CrossRefPubMedGoogle Scholar
  32. 32.
    Sirikci A, Bayazit YA, Bayram M, Mumbuc S, Gungor K, Kanlikama M (2000) Variations of sphenoid and related structures. Eur Radiol 10:844–848CrossRefPubMedGoogle Scholar
  33. 33.
    Takahashi JA, Kawarazaki A, Hashimoto N (2004) Intradural en-bloc removal of the anterior clinoid process. Acta Neurochir (Wien) 146:505–509CrossRefGoogle Scholar
  34. 34.
    Yasargil MG, Gasser JC, Hodosh RM, Rankin TV (1977) Carotid–ophthalmic aneurysms: direct microsurgical approach. Surg Neurol 8:155–165PubMedGoogle Scholar
  35. 35.
    Yonekawa Y, Ogata N, Imhof HG, Olivecrona M, Strommer K, Kwak TE, Roth P, Groscurth P (1997) Selective extradural anterior clinoidectomy for supra- and parasellar processes. Technical note. J Neurosurg 87:636–642CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Bashar Abuzayed
    • 1
  • Necmettin Tanriover
    • 1
    • 4
  • Huseyin Biceroglu
    • 1
  • Odhan Yuksel
    • 1
  • Ozlem Tanriover
    • 2
  • Sait Albayram
    • 3
  • Ziya Akar
    • 1
  1. 1.Department of Neurosurgery, Cerrahpasa Medical FacultyIstanbul UniversityIstanbulTurkey
  2. 2.Department of Family MedicineYeditepe UniversityIstanbulTurkey
  3. 3.Department of Neuroradiology, Cerrahpasa Medical FacultyIstanbul UniversityIstanbulTurkey
  4. 4.Department of NeurosurgeryI.U. Cerrahpasa Medical FacultyIstanbulTurkey

Personalised recommendations