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Endoscopic Extradural Anterior Clinoidectomy via Supraorbital Keyhole: A Cadaveric Study

Komatsu, Fuminari MD, PhD*; Komatsu, Mika MD*; Inoue, Tooru MD, PhD*; Tschabitscher, Manfred MD, PhD‡

doi: 10.1227/NEU.0b013e31821144e5
Surgical Anatomy and Technique

BACKGROUND: Anterior clinoidectomy is an essential preliminary step for parasellar and pericavernous sinus surgery. Endoscopy is a widely accepted modality for neurosurgical strategies and is becoming more important in treating conditions involving the cranial base.

OBJECTIVE: To determine the feasibility of endoscopic extradural anterior clinoidectomy via the supraorbital keyhole.

METHODS: Eight fresh cadaver heads were studied using 4-mm, 0- and 30-degree rigid endoscopes to perform endoscopic extradural anterior clinoidectomy. We also evaluated a bony landmark for this technique in 36 dry craniums.

RESULTS: An endoscope was introduced into the extradural space created via a supraorbital keyhole craniotomy. The periorbita and the duplication of the dura extending to the temporal lobe dura and periorbita were exposed by drilling. Anterior clinoidectomy proceeded using a diamond drill under endoscopic visualization without a dural incision. A submerged view with continuous irrigation through an endoscopic sheath maintained clear visibility while drilling. A small bony eminence at the transition between the sphenoid ridge and the anterior clinoid process, which is an anatomic landmark for endoscopic extradural anterior clinoidectomy, was identified in 57.4% of 36 adult dry craniums.

CONCLUSION: The endoscopic extradural procedure can accomplish reliable anterior clinoidectomy under superb endoscopic visualization. This method would be applicable to parasellar and cavernous sinus surgery combined with keyhole or conventional craniotomy.

*Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan; ‡Center of Anatomy and Cell Biology, Medical University Vienna, Vienna, Austria

Received, June 7, 2010.

Accepted, August 30, 2010.

Correspondence: Fuminari Komatsu, MD, PhD, Department of Neurosurgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Johnan-ku, Fukuoka 814-0180, Japan. E-mail:

Copyright © by the Congress of Neurological Surgeons