The Extended Lateral Supraorbital Approach and Extradural Anterior Clinoidectomy Through a Frontopterio-Orbital Window: Technical Note and Pilot Surgical Series

Andrade-Barazarte, Hugo; Jägersberg, Max; Belkhair, Sirajeddin; Tymianski, Rachel; Turel, Mazda K; Schaller, Karl; Hernesniemi, Juha; Tymianski, Michael; Radovanović, Ivan

doi:10.1016/j.wneu.2016.12.087

Cited by 24 publications

(19 citation statements)

References 19 publications

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“…This means that further frontal lobe retraction is needed to provide sufficient exposure of the surgical target when using the subfrontal corridor, even for approaching the anterior cranial fossa and midline region. 1,9 Moreover, because the dissection of the sylvian fissure is hindered when using an SOa, surgical maneuverability in the middle cranial fossa is also reduced. Some authors have previously shown technical difficulties in approaching middle fossa lesions via an SOa.…”

Section: Discussionmentioning

confidence: 99%

Comparative anatomical analysis between the minipterional and supraorbital approaches

Martínez-Pérez¹,

Albonette-Felicio²,

Hardesty

et al. 2021

Journal of Neurosurgery

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OBJECTIVEKeyhole approaches, namely the minipterional approach (MPTa) and the supraorbital approach (SOa), are alternatives to the standard pterional approach to treat lesions located in the anterior and middle cranial fossae. Despite their increasing popularity and acceptance, the indications and limitations of these approaches require further assessment. The purpose of the present study was to determine the differences in the area of surgical exposure and surgical maneuverability provided by the MPTa and SOa.METHODSThe areas of surgical exposure afforded by the MPTa and SOa were analyzed in 12 sides of cadaver heads by using a microscope and a neuronavigation system. The area of exposure of the region of interest and surgical freedom (maneuverability) of each approach were calculated.RESULTSThe area of exposure was significantly larger in the MPTa than in the SOa (1250 ± 223 mm2 vs 939 ± 139 mm2, p = 0.002). The MPTa provided larger areas of exposure in the ipsilateral and midline compartments, whereas there was no significant difference in the area of exposure in the contralateral compartment. All targets in the anterior circulation had significantly larger areas of surgical freedom when treated via the MPTa versus the SOa.CONCLUSIONSThe MPTa provides greater surgical exposure and better maneuverability than that offered by the SOa. The SOa may be advantageous as a direct corridor for treating lesions located in the contralateral side or in the anterior cranial fossa, but the surgical exposure provided in the midline region is inferior to that exposed by the MPTa.

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Section: Discussionmentioning

confidence: 99%

Comparative anatomical analysis between the minipterional and supraorbital approaches

Martínez-Pérez¹,

Albonette-Felicio²,

Hardesty

et al. 2021

Journal of Neurosurgery

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“…Extradural clinoidectomy allows for a wider bone removal between the optic canal and the superior orbital fissure by providing an easier identification and anatomical orientation than the intradural technique. [24][25][26][27][28][29][30][31][32] With the suspicious of a malignant tumor pathology, one more argument favoring the extradural clinoidectomy is to minimize the possibility of intradural tumor spread. 12 Nonetheless, the long-standing history of the severe visual impairment can explain the lack of any postoperative improvement.…”

Section: Discussionmentioning

confidence: 99%

Anterior Clinoid Metastasis as First Presentation of a Signet Ring Cell Carcinoma: An Intriguing Diagnosis

et al. 2020

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Background We report an extremely unusual case of anterior clinoid process (ACP) metastasis as the first presentation of a signet ring cell carcinoma. Case Description A 54-year-old female patient presented with right-sided visual disturbances due to optic nerve compression from a computed tomography (CT)-identified right anterior clinoid bone lesion. Contrast-enhanced magnetic resonance imaging showed an extra-axial, well-bordered enhancing mass extending from the right ACP toward the inner lumen of the optic canal. Pterional approach was adopted to remove the lesion and decompress the optic canal. Histological examination demonstrated a metastasis from a signet ring cell carcinoma. Postoperative CT showed near-total resection of the tumor and decompression of the optic canal. Visual defect remained unchanged. Conclusion Metastasis should be considered in the differential diagnosis of the ACP lesions. The early suspicion and identification of this extremely rare pathological entity can be helpful for the prompt management of patients, especially in the absence of any other signs of oncological diseases.

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“… 73 Its use for pituitary adenomas, craniopharyngiomas, and clinoidal and tuberculum sellae meningiomas has been described. 1 2 Approach can be pterional, 74 orbitozygomatic, 37 75 modified pterional, 76 modified orbitozygomatic, 40 pretemporal transzygomatic transcavernous, 39 77 temporopolar epidural transcavernous transpetrous, 78 extended lateral supraorbital, 79 and endoscopic transsphenoidal. 24 …”

Section: Discussionmentioning

confidence: 99%

Anterior Clinoid Metastasis Removed Extradurally: First Case Report

2018

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Background We report a case of isolated metastasis on the anterior clinoid process (ACP) mimicking meningioma. Clinical Presentation A 58-year-old male presented with headaches, right-sided visual disturbances, and blurred and double vision. The cause of double vision was partial weakness of the right III nerve, resulting from compression of the nerve by “hypertrophied” tumor-involved right anterior clinoid. Medical history revealed two primary malignant tumors—male breast cancer and prostate cancer (diagnosed 6 and 18 months prior, respectively). The patient was treated with chemotherapy and showed no signs of active disease, recurrence, or metastasis. Postcontrast head magnetic resonance imaging (MRI) showed extra-axial well-bordered enhancing mass measuring 1.6 × 1.1 × 1 × 1 cm (anteroposterior, transverse, and craniocaudal dimensions) on the ACP, resembling a clinoidal meningioma. Extradural clinoidectomy with tumor resection was performed via right orbitozygomatic pretemporal skull base approach. Visual symptoms improved. Follow-up MRI showed no signs of tumor residual or recurrence. Conclusion This is the first case report of a metastasis of any kind on ACP. Metastasis should be included as a part of the differential diagnosis of lesions of the anterior clinoid. Extradural clinoidectomy is a safe and effective method in the treatment of these tumors.

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The Extended Lateral Supraorbital Approach and Extradural Anterior Clinoidectomy Through a Frontopterio-Orbital Window: Technical Note and Pilot Surgical Series

Abstract: The extended LSO approach opens a new route (frontopterio-orbital window) to perform extradural anterior clinoidectomy safely and increases surgical exposure, angles, and operability of a less invasive keyhole craniotomy (LSO approach) to treat anterior cranial fossa lesions.

Cited by 24 publications

References 19 publications

Comparative anatomical analysis between the minipterional and supraorbital approaches

Comparative anatomical analysis between the minipterional and supraorbital approaches

Anterior Clinoid Metastasis as First Presentation of a Signet Ring Cell Carcinoma: An Intriguing Diagnosis

Anterior Clinoid Metastasis Removed Extradurally: First Case Report

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