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Extradural anterior clinoidectomy through endoscopic transorbital approach: laboratory investigation for surgical perspective

  • Original Article - Neurosurgical Anatomy
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Abstract

Background

The endoscopic transorbital approach (eTOA) is a new mini-invasive procedure used to explore different areas of the skull base. Authors propose an extradural anterior clinoidectomy (AC) through this corridor, defining the anatomical landmarks of the anterior clinoid process (ACP) projection onto the posterior orbit wall and the technical feasibility of this approach. We describe the exposure of the opticocarotid region and the surgical freedom and the angles of attack obtained with this novel approach.

Methods

Five cadaver heads underwent an eTOA at the Laboratory of Surgical Neuroanatomy of the University of Barcelona. A step-by-step description of the extradural endoscopic transorbital clinoidectomy was provided. A volumetric analysis of the morphometrics characteristics of the sphenoid wings was evaluated before and after dissection using CT scans. Pterional approach was performed to ascertain ACP removal.

Results

In all the specimens, it was possible to resect the ACP endo-orbitally aiming an optimal optic canal (OC) unroofing. The surface of the triangle corresponding to the ACP projection onto the posterior orbit wall was 0.42 ± 0.20 cm2. The drilled area to perform the extradural clinoidectomy via eTOA was 3.11 ± 2.27 cm2, and the volume of bone removal corresponding to the greater sphenoid wing (GSW) and lesser sphenoid wing (LSW) was 2.55 ± 1.41 and 0.26 ± 0.18 cm3 respectively. The area of surgical freedom provided by the eTOA was (3.11 ± 2.27cm2), and the angles of attack were 21.39 ± 9.13° in the horizontal axel and 30.63 ± 18.51° in the vertical.

Conclusions

The described extradural anterior clinoidectomy by eTOA uses specific landmarks to localize the ACP on the posterior orbit wall. Resection of the ACP is a technically feasible approach, achieving the main goals of any clinoidectomy.

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Abbreviations

AC:

Anterior clinoidectomy

ACP:

Anterior clinoid process

CT:

Computed tomography

eTOA:

Endoscopic transorbital approach

GSW:

Greater sphenoid wing

ICA:

Intracranial carotid artery

IOF:

Inferior orbital fissure

LSW:

Lesser sphenoid wing

MOB:

Meningo-orbital band

OC:

Optic canal

ON:

Optic nerve

OS:

Optic strut

SOF:

Superior orbital fissure

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Acknowledgements

The authors would like to express our sincere gratitude to the body donors and their families, throughout their altruism, made this project possible. The authors also thank Professor Juan Barrena for the artistic drawings dedicated to this paper.

Funding

Spanish Society of Neurosurgery (SENEC) provided financial support in the form of training grant in neuroanatomy. The sponsor had no role in the design or conduct of this research. This project was partially supported by grants from the “Instituto de Salud Carlos III” (PI19/00592) and the “Fundacio La Marato de TV3” (Reg. 95/210; Codi projecte: 201914).

Author information

Authors and Affiliations

  1. Department of Neurosurgery, University Hospital Complex of Albacete, Albacete, Spain

    Cristina Barrena López

  2. Department of Neurosurgery, Hospital Clinic, Barcelona, Spain

    Alberto Di Somma, Thomaz E. Topczewski & Joaquim Enseñat

  3. Laboratory of Surgical Neuroanatomy, Faculty of Medicine, University of Barcelona, Barcelona, Spain

    Alberto Di Somma, Thomaz E. Topczewski & Alberto Prats-Galino

  4. Department of Neurological Surgery, Institut Clínic de Neurociències (ICN), Hospital Clínic de Barcelona, Carrer de Villaroel, 170, 08036, Barcelona, Spain

    Alberto Di Somma

  5. Department of Neurosurgery, Hospital Universitario Río Hortega, Valladolid, Spain

    Santiago Cepeda, Ignacio Arrese & Rosario Sarabia

  6. Department of Otolaryngology-Head and Neck Surgery, Hospital Universitario Rio Hortega, Valladolid, Spain

    Javier Herrero Agustín

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  1. Cristina Barrena López
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Correspondence to Alberto Di Somma.

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Dr. Di Somma is a consultant for Brainlab (participation in speaker’s bureaus). The other authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest of non-financial interest in the subject matter or material discussed in this manuscript.

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López, C.B., Di Somma, A., Cepeda, S. et al. Extradural anterior clinoidectomy through endoscopic transorbital approach: laboratory investigation for surgical perspective. Acta Neurochir 163, 2177–2188 (2021). https://doi.org/10.1007/s00701-021-04896-y

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