Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Acta Neurochirurgica
Published in: Acta Neurochirurgica 6/2013

01-06-2013 | Clinical Article - Neurosurgical Techniques

Safety of drilling for clinoidectomy and optic canal unroofing in anterior skull base surgery

Authors: Sergey Spektor, Shlomo Dotan, Cezar José Mizrahi

Published in: Acta Neurochirurgica | Issue 6/2013

Login to get access

Abstract

Background

Skull base drilling is a necessary and important element of skull base surgery; however, drilling around vulnerable neurovascular structures has certain risks. We aimed to assess the frequency of complications related to drilling the anterior skull base in the area of the optic nerve (ON) and internal carotid artery (ICA), in a large series of patients.

Methods

We included anterior skull base surgeries performed from 2000 to 2012 that demanded unroofing of the optic canal, with extra- or intradural clinoidectomy and/or drilling of the clinoidal process and lateral aspect of the tuberculum sella. Data was retrieved from a prospective database and supplementary retrospective file review. Our IRB waived the requirement for informed consent. The nature and location of pathology, clinical presentation, surgical techniques, surgical morbidity and mortality, pre- and postoperative vision, and neurological outcomes were reviewed.

Results

There were 205 surgeries, including 22 procedures with bilateral optic canal unroofing (227 optic canals unroofed). There was no mortality, drilling-related vascular damage, or brain trauma. Complications possibly related to drilling included CSF leak (6 patients, 2.9 %), new ipsilateral blindness (3 patients, 1.5 %), visual deterioration (3 patients, 1.5 %), and transient oculomotor palsy (5 patients, 2.4 %). In all patients with new neuropathies, the optic and oculomotor nerves were manipulated during tumor removal; thus, new deficits could have resulted from drilling, or tumor dissection, or both.

Conclusion

Drilling of the clinoid process and tuberculum sella, and optic canal unroofing are important surgical techniques, which may be performed relatively safely by a skilled neurosurgeon.
Appendix
Available only for authorised users
Literature
1.
Abuzayed B, Tanriover N, Biceroglu H, Yuksel O, Tanriover O, Albayram S, Akar Z (2010) Pneumatization degree of the anterior clinoid process: a new classification. Neurosurg Rev 33:367–373, discussion 374PubMedCrossRef
2.
Akabane A, Saito K, Suzuki Y, Shibuya M, Sugita K (1995) Monitoring visual evoked potentials during retraction of the canine optic nerve: protective effect of unroofing the optic canal. J Neurosurg 82:284–287PubMedCrossRef
3.
Andaluz N, Beretta F, Bernucci C, Keller JT, Zuccarello M (2006) Evidence for the improved exposure of the ophthalmic segment of the internal carotid artery after anterior clinoidectomy: morphometric analysis. Acta Neurochir (Wien) 148:971–975, discussion 975–976CrossRef
4.
Batjer HH, Kopitnik TA, Giller CA, Samson DS (1994) Surgery for paraclinoidal carotid artery aneurysms. J Neurosurg 80:650–658PubMedCrossRef
5.
Chang DJ (2009) The “no-drill” technique of anterior clinoidectomy: a cranial base approach to the paraclinoid and parasellar region. Neurosurgery 64:ons96–ons105, discussion ons105–106PubMedCrossRef
6.
Chang HS, Joko M, Song JS, Ito K, Inoue T, Nakagawa H (2006) Ultrasonic bone curettage for optic canal unroofing and anterior clinoidectomy. Technical note. J Neurosurg 104:621–624PubMedCrossRef
7.
Chi JH, Sughrue M, Kunwar S, Lawton MT (2006) The “yo-yo” technique to prevent cerebrospinal fluid rhinorrhea after anterior clinoidectomy for proximal internal carotid artery aneurysms. Neurosurgery 59:ONS101–ONS107, discussion ONS101–107PubMed
8.
Couldwell WT, Kan P, Liu JK, Apfelbaum RI (2006) Decompression of cavernous sinus meningioma for preservation and improvement of cranial nerve function. Technical note. J Neurosurg 105:148–152PubMedCrossRef
9.
Day AL (1990) Aneurysms of the ophthalmic segment. A clinical and anatomical analysis. J Neurosurg 72:677–691PubMedCrossRef
10.
Day JD, Giannotta SL, Fukushima T (1994) Extradural temporopolar approach to lesions of the upper basilar artery and infrachiasmatic region. J Neurosurg 81:230–235PubMedCrossRef
11.
De Jesús O, Sekhar LN, Riedel CJ (1999) Clinoid and paraclinoid aneurysms: surgical anatomy, operative techniques, and outcome. Surg Neurol 51:477–487, discussion 487–478PubMedCrossRef
12.
Dolenc VV (1985) A combined epi- and subdural direct approach to carotid-ophthalmic artery aneurysms. J Neurosurg 62:667–672PubMedCrossRef
13.
Froelich SC, Aziz KM, Levine NB, Theodosopoulos PV, van Loveren HR, Keller JT (2007) Refinement of the extradural anterior clinoidectomy: surgical anatomy of the orbitotemporal periosteal fold. Neurosurgery 61:179–185, discussion 185–176PubMedCrossRef
14.
Gonzalez-Darder JM (2007) Intradural anterior clinoidectomy. Anatmoclinical study and its usefulness in the treatment of trans-segmentary C5-C6 trans-segmentary paraclinoid aneurysms. Neurocirugia (Astur) 18:201–208
15.
Hadeishi H, Suzuki A, Yasui N, Satou Y (2003) Anterior clinoidectomy and opening of the internal auditory canal using an ultrasonic bone curette. Neurosurgery 52:867–870, discussion 870–861PubMedCrossRef
16.
Heros RC, Nelson PB, Ojemann RG, Crowell RM, DeBrun G (1983) Large and giant paraclinoid aneurysms: surgical techniques, complications, and results. Neurosurgery 12:153–163PubMedCrossRef
17.
Huynh-Le P, Natori Y, Sasaki T (2004) Surgical anatomy of the anterior clinoid process. J Clin Neurosci 11:283–287PubMedCrossRef
18.
Kim JM, Romano A, Sanan A, van Loveren HR, Keller JT (2000) Microsurgical anatomic features and nomenclature of the paraclinoid region. Neurosurgery 46:670–680, discussion 680–672PubMedCrossRef
19.
Kim K, Isu T, Matsumoto R, Isobe M, Kogure K (2006) Surgical pitfalls of an ultrasonic bone curette (SONOPET) in spinal surgery. Neurosurgery 59:ONS390–ONS393, discussion ONS393PubMed
20.
Kulwin C, Tubbs RS, Cohen-Gadol AA (2011) Anterior clinoidectomy: description of an alternative hybrid method and a review of the current techniques with an emphasis on complication avoidance. Surg Neurol Int 2:140PubMedCrossRef
21.
Lee JH, Sade B, Park BJ (2006) A surgical technique for the removal of clinoidal meningiomas. Neurosurgery 59:ONS108–ONS114, discussion ONS108–114PubMedCrossRef
22.
Li-Hua C, Ling C, Li-Xu L (2011) Microsurgical management of tuberculum sellae meningiomas by the frontolateral approach: surgical technique and visual outcome. Clin Neurol Neurosurg 113:39–47PubMedCrossRef
23.
Mariniello G, de Divitiis O, Bonavolonta G, Maiuri F (2013) Surgical unroofing of the optic canal and visual outcome in basal meningiomas. Acta Neurochir (Wien) 155:77–84CrossRef
24.
Mikami T, Minamida Y, Koyanagi I, Baba T, Houkin K (2007) Anatomical variations in pneumatization of the anterior clinoid process. J Neurosurg 106:170–174PubMedCrossRef
25.
Noguchi A, Balasingam V, Shiokawa Y, McMenomey SO, Delashaw JB Jr (2005) Extradural anterior clinoidectomy. Technical note. J Neurosurg 102:945–950PubMedCrossRef
26.
Nutik SL (1988) Removal of the anterior clinoid process for exposure of the proximal intracranial carotid artery. J Neurosurg 69:529–534PubMedCrossRef
27.
Romani R, Elsharkawy A, Laakso A, Kangasniemi M, Hernesniemi J (2012) Complications of anterior clinoidectomy through lateral supraorbital approach. World Neurosurg 77:698–703PubMedCrossRef
28.
Smith RR, Al-Mefty O, Middleton TH (1989) An orbitocranial approach to complex aneurysms of the anterior circulation. Neurosurgery 24:385–391PubMedCrossRef
29.
Takahashi JA, Kawarazaki A, Hashimoto N (2004) Intradural en-bloc removal of the anterior clinoid process. Acta Neurochir (Wien) 146:505–509CrossRef
30.
31.
Yaşargil MG, Gasser JC, Hodosh RM, Rankin TV (1977) Carotid-ophthalmic aneurysms: direct microsurgical approach. Surg Neurol 8:155–165PubMed
32.
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 87:636–642PubMedCrossRef
Metadata
Title
Safety of drilling for clinoidectomy and optic canal unroofing in anterior skull base surgery
Authors
Sergey Spektor
Shlomo Dotan
Cezar José Mizrahi
Publication date
01-06-2013
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 6/2013
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-013-1704-2

Other articles of this Issue 6/2013

Acta Neurochirurgica 6/2013 Go to the issue

Review Article - Neurosurgical Anatomy

Progressive nerve territory overgrowth after subtotal resection of lipomatosis of the median nerve in the palm and wrist: a case, a review and a paradigm

Clinical Article - Functional

Incorporation of the experience of patients in the development of a patient-reported outcome measures (PROM) for carpal tunnel syndrome

Clinical Article - Brain Tumors

Fusiform dilatation of the cavernous carotid artery in acromegalic patients

Clinical Article - Brain Tumors

Image-guided resection of spheno-orbital skull-base meningiomas with predominant intraosseous component

Letter to the editor - Brain Tumors

Human chorionic gonadotropin elevation is not an intracranial germ cell tumor signature

Clinical Article - Brain Tumors

Intracranial meningiomas and neurofibromatosis type 2