Skip to main content

Advertisement

SpringerLink
Log in

How I do it: a purely endoscopic endonasal approach for anterior clinoidal meningioma

  • How I Do It - Tumor - Meningioma
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Surgery for anterior clinoid meningiomas (ACMs) remains challenging due to their tight adhesion to vital neurovascular and has been traditionally performed through a transcranial approach.

Method

We present the key steps of the endoscopic endonasal approach (EEA) for ACMs with a video illustration and figures. The relevant surgical anatomy is described along with the indications and limitations of this approach.

Conclusion

The EEA offers a good treatment option for selected ACMs. It allows for the removal of involved hyperostotic bone and dural attachments, early identification and control of the neurovascular structure, and avoidance of brain retraction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data Availability

All data generated or analyzed during this study are included in this published article and its supplementary information files.

Abbreviations

ACMs:

Anterior clinoidal meningiomas

EEA:

Endoscopic endonasal approach

ICA:

Internal carotid artery

ACP:

Anterior clinoid process

ON:

Optic nerve

OC:

Optic canal

SOF:

Superior orbital fissure

LOCR:

Lateral opticocarotid recess

References

  1. Al-Mefty O (1990) Clinoidal meningiomas. J Neurosurg 73:840–849

    Article  CAS  PubMed  Google Scholar 

  2. Bardeesi AM, Alsaleh S, Ajlan AM (2017) Endoscopic transnasal suprasellar approach for anterior clinoidal meningioma: a case report and review of the literature. Surg Neurol Int 8:194

    Article  PubMed  PubMed Central  Google Scholar 

  3. Huynh-Le P, Natori Y, Sasaki T (2004) Surgical anatomy of the anterior clinoid process. J Clin Neurosci 11:283–287

    Article  PubMed  Google Scholar 

  4. Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL (2005) Expanded endonasal approach: the rostrocaudal axis. Part I. Crista galli to the sella turcica. Neurosurg Focus 19:E3

  5. Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL (2005) Expanded endonasal approach: the rostrocaudal axis. Part II. Posterior clinoids to the foramen magnum. Neurosurg Focus 19:E4

  6. Labib MA, Prevedello DM, Fernandez-Miranda JC, Sivakanthan S, Benet A, Morera V, Carrau R, Kassam A (2013) The medial opticocarotid recess: an anatomic study of an endoscopic “key landmark” for the ventral cranial base. Neurosurgery 72(66–76):76

    PubMed  Google Scholar 

  7. Rhoton AJ (2002) The cavernous sinus, the cavernous venous plexus, and the carotid collar. Neurosurgery 51:S375–S410

    Article  PubMed  Google Scholar 

  8. Romani R, Laakso A, Kangasniemi M, Lehecka M, Hernesniemi J (2011) Lateral supraorbital approach applied to anterior clinoidal meningiomas: experience with 73 consecutive patients. Neurosurgery 68(1632–1647):1647

    PubMed  Google Scholar 

  9. Starnoni D, Tuleasca C, Giammattei L, Cossu G, Bruneau M, Berhouma M, Cornelius JF, Cavallo L, Froelich S, Jouanneau E, Meling TR, Paraskevopoulos D, Schroeder H, Tatagiba M, Zazpe I, Sufianov A, Sughrue ME, Chacko AG, Benes V, Gonzalez-Lopez P, Roche PH, Levivier M, Messerer M, Daniel RT (2021) Surgical management of anterior clinoidal meningiomas: consensus statement on behalf of the EANS skull base section. Acta Neurochir (Wien) 163:3387–3400

    Article  CAS  PubMed  Google Scholar 

  10. Xiao L, Xie S, Tang B, Hu J, Hong T (2019) Endoscopic endonasal anterior clinoidectomy: surgical anatomy, technique nuance, and case series. J Neurosurg:1–11

Download references

Acknowledgements

We express our sincere appreciation to Miss Long Mei Zeng for the illustration.

Funding

This study was supported by the National Natural Science Foundation of China (grant nos. 82060246 and 81460381), the Ganpo555 Engineering Excellence of Jiangxi Science and Technology Department (2013), and the Key Research and Invention Plan of Jiangxi Science and Technology Department (20192BBG70026).

Author information

Authors and Affiliations

  1. Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, China

    You Yuan Bao, Li Min Xiao, Bin Tang & Tao Hong

Authors
  1. You Yuan Bao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Li Min Xiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bin Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tao Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Tao Hong contributed to the study conception and design. Material preparation and data collection were performed by You Yuan Bao, Li Min Xiao, and Bin Tang. The first draft of the manuscript was written by You Yuan Bao. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Tao Hong.

Ethics declarations

Ethics approval

Anatomical study with cadaver heads and human subject approval was obtained from the Institutional Ethics Committee of the First Affiliated Hospital of Nanchang University prior to the commencement of the study. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent for publication

All the authors gave consent for the publication of the article.

Conflicts of interest

The authors declare no competing interests.

Additional information

Key points

1. The EEA provides a good treatment option for well-selected ACMs.

2. The surgical anatomy of the ACP and its relationship with adjacent structures must be fully understood from an endoscopic perspective.

3. A detailed study of preoperative neuroradiological examination including MRI and fine-cut CT images is mandatory, especially the extent of the pneumatization of the sphenoid sinus and the involvement of the OC and ACP.

4. The bone must be removed under continuous irrigation to prevent thermal damage to neurovascular structures.

5. Individualized anterior clinoidectomy is strongly recommended according to disease-specific management.

6. While the involved dura and bone are removed, the corridor to subdural lesions is also established.

7. Intraoperative neuronavigation and electrophysiological monitoring are routinely used throughout the operation.

8. In the case of significant adhesion to neurovascular structures, some tumor residues can be tolerated and may necessitate adjuvant radiosurgery.

9. A long-term follow-up is required to observe any tumor recurrence.

10. A team proficient in microvascular and endoscopic techniques is a prerequisite for the safe and successful resection of ACMs.

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Tumor—Meningioma

You Yuan Bao contributed to this work.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bao, Y.Y., Xiao, L.M., Tang, B. et al. How I do it: a purely endoscopic endonasal approach for anterior clinoidal meningioma. Acta Neurochir 165, 543–548 (2023). https://doi.org/10.1007/s00701-022-05480-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-022-05480-8

Keywords

Search

Navigation