Extradural anterior clinoidectomy in the management of parasellar meningiomas: Analysis of 13 years of experience and literature review

López, Laura Salgado; Hernández, Fernando Muñoz; Cortés, Carlos Asencio; Ribó, Pere Tresserras i; Holzapfel, María Jesús Álvarez; Teixidó, Joan Molet

doi:10.1016/j.neucie.2018.04.001

Cited by 8 publications

(15 citation statements)

References 33 publications

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“…In 1985, Dolenc published an article about the combined approach as a path to the treatment of carotid ophthalmic aneurysms and then popularized the extradural technique [ 5 , 7 ]. Since then, several authors have been describing new techniques of AC for many parasellar lesions [ 3 , 7 , 8 , 11 - 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…They can increase the safety of AC by providing easily identifiable landmarks and reducing intradural bone drilling, which could put the adjacent neurovascular structures at risk [ 8 ]. The hybrid technique can be useful for complex lesions with important anatomical deformation [ 3 , 6 - 7 , 10 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…In such cases, intradural is preferred over extradural AC with cervical carotid artery control [ 24 ]. Nevertheless, a preoperative thin-slice CT scan with 3D reconstruction is essential for an adequate understanding of the ACP anatomy as a pneumatization pattern, ligament ossification, hypertrophy, or even bone erosion [ 3 , 23 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…Lesser sphenoid wing en plaque meningiomas with ocular proptosis usually require extradural AC and orbital roof resection [ 24 - 26 ]. In cases of small type III anterior clinoidal meningioma, the extradural AC technique provides an exaggerated bone exposure and high risk of neurovascular injuries [ 1 , 3 - 4 , 27 - 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…Anterior clinoidectomy (AC) is a key microsurgical step for the safe and successful management of paraclinoid aneurysms and parasellar neoplastic lesions, increasing the surgical path through the opticocarotid and carotid-oculomotor triangles and allowing the decompression and safe mobilization of the optic nerve [ 3 - 5 ]. Two main techniques have been used, the extradural and the intradural AC [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Tailored Anterior Clinoidectomy: Beyond the Intradural and Extradural Concepts

Pacheco

Melo

Acioly

et al. 2021

Cureus

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Anterior clinoidectomy (AC) is a key microsurgical step for the safe and successful management of parasellar pathologies that involve the anterior clinoid process (ACP) and the optic canal. Traditionally, extra and intradural ACs are performed separately according to the surgeon's experience or preference. The objective is to present and discuss the tailored AC concept through illustrative cases. We conducted a retrospective record review of three patients who underwent AC as a surgical step for the treatment of parasellar pathologies that involve the ACP and optic canal. A review of the relevant literature on AC was performed in the PubMed, LILACS, and SciELO databases. In all three cases, the pterional craniotomy was the preferred approach for AC. Case 1, a 47-year-old female patient with type III anterior clinoidal meningioma, underwent a tailored intradural technique (optic canal unroofing) with total tumor resection and complete visual recovery. Case 2, a 63-year-old female patient with a complex type II anterior clinoidal meningioma with extensive hyperostosis of the ACP, underwent a hybrid AC technique with complete removal of the tumor and visual improvement. Case 3, a 62-year-old female, underwent a tailored intradural AC for clipping an incidental carotid-ophthalmic aneurysm. Tailored AC aims to provide adequate exposure with less risk of neurovascular injury, allowing enough space to safely treat parasellar lesions. The type, size, and location of the lesion, as well as the surgeon’s experience, should always be considered for surgical planning.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Tailored Anterior Clinoidectomy: Beyond the Intradural and Extradural Concepts

Pacheco

Melo

Acioly

et al. 2021

Cureus

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Surgical management of anterior clinoidal meningiomas: consensus statement on behalf of the EANS skull base section

et al. 2021

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Background The optimal management of clinoidal meningiomas (CMs) continues to be debated. Methods We constituted a task force comprising the members of the EANS skull base committee along with international experts to derive recommendations for the management of these tumors. The data from the literature along with contemporary practice patterns were discussed within the task force to generate consensual recommendations. Results and conclusion This article represents the consensus opinion of the task force regarding pre-operative evaluations, patient’s counselling, surgical classification, and optimal surgical strategy. Although this analysis yielded only Class B evidence and expert opinions, it should guide practitioners in the management of patients with clinoidal meningiomas and might form the basis for future clinical trials.

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