Endoscopic endonasal posterior clinoidectomy

Danilo Silva, Moshe Attia, Jothy Kandasamy, Marjan Alimi, Vijay K. Anand, Theodore H. Schwartz*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

21 Scopus citations

Abstract

Background: Posterior clinoidectomy is a useful procedure for maximizing exposure to the interpeduncular cistern via transcranial approaches for basilar tip aneurysms and select intracranial tumors. The value of posterior clinoidectomy during endonasal endoscopic transclival surgery is not well described. Methods: We performed endoscopic endonasal transsphenoidal extradural bilateral posterior clinoidectomy and dorsum sella removal on five silicon-injected cadaveric heads. The dorsum sella was split in the midline and removed from medial to lateral until the posterior clinoids were encountered. The posterior clinoid was dissected from the medial wall of the cavernous sinus and mobilized medially in order to detach it from the ligaments and carefully fractured it from the bony attachment to the petrous apex and carotid canal. Following this, the clival and dorsum sella dura was opened to expose the interpeduncular cistern and its contents. Results: The technical feasibility of endoscopic endonasal extradural posterior clinoidectomy was reproduced in all five cadaveric specimens. This technique was performed without damaging the vital structures, including preservation of the pituitary gland. After performing bilateral posterior clinoidectomy, the retrosellar dura was opened, allowing good visualization of the contents of the prepontine and interpeduncular cistern. Conclusion: We describe the technique of endoscopic endonasal extradural posterior clinoidectomy. We believe this approach is best suited for retrosellar pathology located in the interpeduncular cistern and is a useful adjunct to the transclival approach to increase the field of view and maximize the extent of resection.

Original languageEnglish
Article number97008
JournalSurgical Neurology International
Volume3
Issue number1
DOIs
StatePublished - 1 Jan 2012
Externally publishedYes

Keywords

  • Dorsum sella
  • endoscopic endonasal
  • extradural posterior clinoidectomy
  • interpeduncular cistern
  • posterior clinoid process
  • skull base

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