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Intra- and extradural anterior clinoidectomy: anatomy review and surgical technique step by step

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Abstract

Purpose

The complex relations of the paraclinoid area make the surgical management of the pathology of this region a challenge. The anterior clinoid process (ACP) is an anatomical landmark that hinders the visualization and manipulation of the surrounding neurovascular structures, hence in certain surgical interventions might be necessary to remove it. We reviewed the anatomical relationships that involve the paraclinoid area and detailed the step-by-step techniques of intra and extradural clinoidectomy in cadaveric specimens.

Materials and methods

A literature review was done describing the most relevant anatomic relationships regarding the anterior clinoid process. Extradural and intradural clinoidectomy techniques were performed in six dry bone heads and in ten previously injected cadaverous specimens with colored latex (Sanan et al. in Neurosurgery 45:1267–1274, 1999) and each step of the procedure was recorded using photographic material. Finally, an analysis of the anatomical exposure achieved in each of the techniques used was performed.

Results

The main advantage of the intradural clinoidectomy technique is the direct visualization of the neurovascular structures adjacent to the ACP when drilling, at the same time, opening the Sylvian fissure will allow the direct visualization of the ACP variants. The main advantage offered by the extradural technique is that the dura protects adjacent eloquent structures while drilling. Among the disadvantages, it is noted that the same dura that would protect the underlying structures also prevents the direct visualization of these neurovascular structures adjacent to the ACP.

Conclusion

We reviewed the anatomy of the paraclinoid area and made a step-by-step description of the technique of the anterior clinoidectomy in its intra- and extradural variants in cadaveric preparations for a better understanding.

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Funding

The authors declare that we have no funding.

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Authors and Affiliations

  1. Department of Neurosurgery, Hospital de Alta Complejidad El Cruce, Buenos Aires, Argentina

    Federico Carlos Gallardo, Jorge Luis Bustamante, Clara Martin, Aylen Andrea Targa Garcia, Santiago Enrique Feldman, Marcelo Cristian Orellana & Pablo Augusto Rubino

  2. Department of Neurosurgery, Hospital Clínic Universitari de València, Valencia, Spain

    Felix Pastor & Vicent Quilis Quesada

  3. College of Medicine and Science, Mayo Clinic, Rochester, USA

    Vicent Quilis Quesada

  4. Department of Human Anatomy and Embryology, Faculty of Medicine, University of Valencia, Valencia, Spain

    Vicent Quilis Quesada

Authors
  1. Federico Carlos Gallardo
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  2. Jorge Luis Bustamante
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  3. Clara Martin
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  4. Aylen Andrea Targa Garcia
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Contributions

GFC: manuscript writing, BJL: manuscript editing, MC: manuscript writing, TGAA: review and editing, FSE: review and editing, PF: resources: data curation, OCM: visualization, RPA: project development, QQV: resources and project development.

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Correspondence to Federico Carlos Gallardo.

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Gallardo, F.C., Bustamante, J.L., Martin, C. et al. Intra- and extradural anterior clinoidectomy: anatomy review and surgical technique step by step. Surg Radiol Anat 43, 1291–1303 (2021). https://doi.org/10.1007/s00276-021-02681-1

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