Modified Extradural Temporopolar Approach for Paraclinoid Aneurysms: Operative Nuance and Surgical Result

  • Naoki OtaniEmail author
  • Terushige Toyooka
  • Satoru Takeuchi
  • Arata Tomiyama
  • Yasuaki Nakao
  • Takuji Yamamoto
  • Kojiro Wada
  • Kentaro Mori
Conference paper
Part of the Acta Neurochirurgica Supplement book series (NEUROCHIRURGICA, volume 129)


Background. Extradural temporopolar approach can provide extensive exposure of the anterior clinoid process, which can prevent intraoperative neurovascular injury in anterior clinoidectomy for paraclinoid aneurysms. The present study investigates the usefulness of this modified technique, and operative nuances are discussed here.

Methods. We retrospectively reviewed the medical charts of 30 consecutive patients with paraclinoid aneurysms who underwent treatment with this modified extradural temporopolar approach between September 2009 and March 2016.

Results. Worsening of visual acuity was documented postoperatively in three patients (10.0%), and visual field function worsened in three patients (10.0%). Postoperative outcome was good recovery in all patients. No operation-related mortality occurred in the series.

Conclusion. Extradural anterior clinoidectomy via the modified extradural temporopolar approach is safe and may be recommended for surgical treatment of paraclinoid aneurysms to reduce the risk of intraoperative optic neurovascular injury.


Extradural temporopolar approach Paraclinoid anevurysm Skull base surgery Microneurosurgery 


Conflict of Interest Statement

There is no potential COI which should be disclosed.


  1. 1.
    Dolenc VV. Direct microsurgical repair of intracavernous vascular lesions. J Neurosurg. 1983;58:824–31.CrossRefGoogle Scholar
  2. 2.
    Day JD, Giannotta SL, Fukushima T. Extradural temporopolar approach to lesions of the upper basilar artery and infrachiasmatic region. J Neurosurg. 1994;81:230–5.CrossRefGoogle Scholar
  3. 3.
    Yoon BH, Kim HK, Park MS, Kim SM, Chung SY, Lanzino G. Meningeal layers around anterior clinoid process as a delicate area in extradural anterior clinoidectomy: anatomical and clinical study. J Korean Neurosurg Soc. 2012;52:391–5.CrossRefGoogle Scholar
  4. 4.
    Otani N, Wada K, Toyooka T, Fujii K, Kobayashi Y, Mori K. Operative surgical nuances of modified extradural temporopolar approach with mini-peeling of dura propria based on cadaveric anatomical study of lateral cavernous structures. Surg Neurol Int. 2016;7(Suppl 16):S454–8.CrossRefGoogle Scholar
  5. 5.
    Otani N, Wada K, Toyooka T, Fujii K, Ueno H, Tomura S, Tomiyama A, Nakao Y, Yamamoto T, Mori K. Usefulness of suction decompression method combined with extradural temporopolar approach during clipping of complicated internal carotid artery aneurysm. World Neurosurg. 2016;90:293–9.CrossRefGoogle Scholar
  6. 6.
    Day AL. Aneurysms of the ophthalmic segment. A clinical and anatomical analysis. J Neurosurg. 1990;72:677–91.CrossRefGoogle Scholar
  7. 7.
    Nutik SL. Removal of the anterior clinoid process for exposure of the proximal intracranial carotid artery. J Neurosurg. 1988;69:529–34.CrossRefGoogle Scholar
  8. 8.
    Yonekawa Y, Ogata N, Imhof HG, Olivecrona M, Strommer K, Kwak TE, Roth P, Groscurth P. Selective extradural anterior clinoidectomy for supra- and parasellar processes. Technical note. J Neurosurg. 1997;87:636–42.CrossRefGoogle Scholar
  9. 9.
    Otani N, Muroi C, Yano H, Khan N, Pangalu A, Yonekawa Y. Surgical management of tuberculum sellae meningioma: role of of selective extradural anterior clinoidectomy. Br J Neurosurg. 2006;20:129–38.CrossRefGoogle Scholar
  10. 10.
    Coscarella E, Bakaya MK, Morcos JJ. An alternative extradural exposure to the anterior clinoid process: the superior orbital fissure as a surgical corridor. Neurosurgery. 2003;53:162–6.CrossRefGoogle Scholar
  11. 11.
    Noguchi A, Balasingam V, Shiokawa Y, McMenomey SO, Delashaw JB Jr. Extradural anterior clinoidectomy. Technical note. J Neurosurg. 2005;102:945–50.CrossRefGoogle Scholar
  12. 12.
    Mori K, Yamamoto T, Oyama K, Ueno H, Nakao Y, Honma K. Modified three-dimensional skull base model with artificial dura mater, cranial nerves, and venous sinuses for training in skull base surgery: technical note. Neurol Med Chir (Tokyo). 2008;48:582–7.CrossRefGoogle Scholar
  13. 13.
    Mori K. Dissectable modified three-dimensional temporal bone and whole skull base models for training in skull base approaches. Skull Base. 2009;19:333–44.CrossRefGoogle Scholar
  14. 14.
    Mori K, Yamamoto T, Oyama K, Nakao Y. Modification of three-dimensional prototype temporal bone model for training in skull-base surgery. Neurosurg Rev. 2009;32:233–8.CrossRefGoogle Scholar
  15. 15.
    Evans JJ, Hwang YS, Lee JH. Pre- versus post-anterior clinoidectomy measurements of the optic nerve, internal carotid artery and opticocarotid triangle. A cadaveric morphometric study. Neurosurgery. 2000;46:1018–23.PubMedGoogle Scholar
  16. 16.
    Sade B, Kweon CY, Evans JJ, Lee JH. Enhanced exposure of caroticooculomotor triangle following extradural anterior clinoidectomy: a comparative anatomical study. Skull Base. 2005;15:157–61.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Naoki Otani
    • 1
    Email author
  • Terushige Toyooka
    • 1
  • Satoru Takeuchi
    • 1
  • Arata Tomiyama
    • 1
  • Yasuaki Nakao
    • 2
  • Takuji Yamamoto
    • 2
  • Kojiro Wada
    • 1
  • Kentaro Mori
    • 1
  1. 1.Department of NeurosurgeryNational Defense Medical CollegeTokorozawaJapan
  2. 2.Department of NeurosurgeryJuntendo University Shizuoka HospitalIzunokuniJapan

Personalised recommendations