Elsevier

World Neurosurgery

Volume 77, Issues 5–6, May–June 2012, Pages 698-703
World Neurosurgery

Peer-Review Report
Complications of Anterior Clinoidectomy Through Lateral Supraorbital Approach

https://doi.org/10.1016/j.wneu.2011.08.014Get rights and content

Objective

We reviewed the surgical complications from our recent experience in vascular and tumor patients who underwent anterior clinoidectomy through the lateral supraorbital (LSO) approach.

Methods

Between June 2007 and January 2011, a total of 82 patients with neoplastic and vascular lesions underwent anterior clinoidectomy by the senior author (J.H.) through the LSO approach. We analyzed the operative videos paying particular attention to the surgical technique used for removal of the anterior clinoid process (ACP) and compared the microsurgical nuances to postoperative complications related to anterior clinoidectomy.

Results

Forty-five patients were treated for aneurysms; 35 patients for intraorbital, parasellar, and suprasellar tumors; and 2 patients for carotid-cavernous fistulas. Intradural anterior clinoidectomy was performed in 67 (82%) cases; in 15 (18%) cases an extradural approach was used. In 51 (62%) cases, ACP was removed completely, whereas in the remaining 31 (38%) a tailored anterior clinoidectomy was performed. Four (5%) patients had new postoperative visual deficits and 3 (4%) experienced a worsening of preoperative visual deficits. Twelve (15%) patients improved their preoperative visual deficits after intradural anterior clinoidectomy. Ultrasonic bone device is a useful tool but may damage the optic nerve when performing anterior clinoidectomy. There was no mortality in our series.

Conclusion

Anterior clinoidectomy can be performed through an LSO approach with a safety profile that is comparable to other approaches. Ultrasonic bone dissector is a useful tool but may lead to injury of the optic nerve and should be used very carefully in its vicinity.

Introduction

Anterior clinoidectomy, which is necessary for the treatment of neoplastic and vascular lesion of the sellar and parasellar regions (5, 7, 14, 41, 44), may be associated with many complications. The technique of anterior clinoidectomy for the treatment of carotid-ophthalmic aneurysms and intraorbital and parasellar tumors via intradural and extradural routes and pterional and orbitozygomatic approaches have been published by several authors since the late 1960s (3, 5, 6, 7, 8, 11, 13, 16, 25, 27, 28, 29, 30, 31, 38, 39, 40, 41, 42, 43, 44).

We have recently described in detail the microsurgical technique for “tailored” anterior clinoidectomy through a lateral supraorbital (LSO) approach used for the present series. For the present report, we analyzed the surgical complications related to the anterior clinoidectomy performed using this technique, paying special attention to the technical nuances used during the surgical procedure.

This series consists of 82 patients operated on by the senior author (J.H.) (assisted by R.R.) between June 2007 and January 2011 at the Department of Neurosurgery of Helsinki University Central Hospital, Finland.

Section snippets

Data Collection

Between June 2007 and January 2011, a total of 82 patients underwent anterior clinoidectomy through LSO approach for vascular and neoplastic lesions at the Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland, by the senior author (J.H.). The clinical and demographic data of these patients are presented in Table 1. Preoperative clinical conditions were expressed on the Karnofsky performance scale (19) for neoplastic lesions and on the Hunt-Hess (HH) scale (15) for

Tailored Anterior Clinoidectomy

We performed tailored clinoidectomy as described in detail previously (32). We removed only the portion of the anterior clinoid process (ACP) necessary for the treatment of the lesion (Table 2). We have classified the extent of removal as follows: 1) the tip of ACP (less than one-third of the ACP); 2) the tip and the head of the ACP (approximately one-third of the ACP); 3) the tip, the head, and the body of the ACP (approximately two-thirds of the ACP); and 4) the whole ACP. In eight patients

Discussion

In this article, we have analyzed the clinical outcome and surgical complications of our recent consecutive series of 82 patients who have undergone anterior clinoidectomy through the LSO approach for the treatment of aneurysms or neoplastic lesions in the sellar and parasellar regions, with the aim of 1) comparing the outcome of our series to other published series using different (generally more extensive) approaches and 2) understanding the technical nuances mostly affecting outcome. Because

Conclusion

Anterior clinoid process can be removed through the LSO approach with low morbidity comparable to anterior clinoidectomy performed via other, more extensive approaches. Ultrasonic bone dissector is a useful tool but may lead to injury of optic nerve and should be used very carefully in its vicinity.

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    Conflict of interest statement: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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