Article Sidebar

PDF (Tiếng Việt)
Published: 2026-03-09
Abstract Views: 0
Views PDF (Tiếng Việt): 0
DOI: https://doi.org/10.52852/tcncyh.v199i2.4663
Issue
Vol. 199 No. 2 (2026)
Section
Các bài báo
How to Cite
Duy, P., Nghiêm, N. X., Tùng, T. S., & Hùng, N. M. (2026). Extradural anterior clinoidectomy approach for paraclinoid skull base lesions. Journal of Medical Research, 199(2), 368-377. https://doi.org/10.52852/tcncyh.v199i2.4663

Extradural anterior clinoidectomy approach for paraclinoid skull base lesions

Pham Duy, Nguyen Xuan Nghiem, Tran Son Tung, Ngo Manh Hung

Main Article Content

Abstract

The anterior clinoid process (ACP) is intimately related to critical structures such as the optic nerve, the internal carotid artery (ICA), and the cavernous sinus. Adequate exposure of paraclinoid lesions necessitates the removal of the ACP, and the extradural anterior clinoidectomy (EAC) technique offers distinct advantages in protecting intradural neurovascular structures. We describe the technique of extradural anterior clinoidectomy and report our preliminary results. This retrospective descriptive study included 11 patients who underwent surgical treatment for paraclinoid skull base lesions using the EAC technique at Viet Duc University Hospital from August 2024 to May 2025. The cohort included 7 females and 4 males with a mean age of 46.91 ± 20.11 years old. The pathologies comprised 3 cases of paraclinoid ICA aneurysms, 1 case of posterior communicating artery aneurysm, 4 cases of sphenoid wing meningiomas, 2 cases of retrochiasmatic craniopharyngiomas, and 1 case of skull base fibrous dysplasia. Extradural anterior clinoidectomy plays a crucial role in the surgical management of paraclinoid skull base pathologies. A thorough understanding of the anatomy of the ACP and adjacent neurovascular structures is essential for ensuring surgical safety.

Article Details

Keywords

Extradural anterior clinoidectomy, anterior clinoid process, internal Carotid Artery

References

1. Rhoton AL Jr. The sellar region. Neurosurgery. 2002; 51(4 Suppl): S335-S374.
2. Krisht AF. The Clinoidal Cone: Microsurgical Anatomy. Contemporary Neurosurgery. 2019; 41(14): 1-5. doi:10.1097/01.CNE.0000651472.15941.a1.
3. Coscarella E, Başkaya MK, Morcos JJ. An Alternative Extradural Exposure to the Anterior Clinoid Process: The Superior Orbital Fissure as a Surgical Corridor. Neurosurgery. 2003; 53(1): 162-167. doi:10.1227/01.NEU.0000068866.22176.07.
4. Froelich SC, Aziz KMA, Levine NB, Theodosopoulos PV, van Loveren HR, Keller JT. Refinement of the extradural anterior clinoidectomy: surgical anatomy of the orbitotemporal periosteal fold. Operative Neurosurgery. 2007; 61(5): 179. doi:10.1227/01.neu.0000303215.76477.cd.
5. Dolenc VV. Frontotemporal epidural approach to trigeminal neurinomas. Acta Neurochir (Wien). 1994; 130(1-4): 55-65. doi:10.1007/BF01405503.
6. Kulwin C, Tubbs RS, Cohen-Gadol AA. Anterior clinoidectomy: Description of an alternative hybrid method and a review of the current techniques with an emphasis on complication avoidance. Surg Neurol Int. 2011; 2: 140. doi:10.4103/2152-7806.85981.
7. Troude L, Bernard F, Bauchet G, De La Rosa Morilla S, Roche PH. Extradural resection of the anterior clinoid process: How I do it. Neurochirurgie. 2017; 63(4): 336-340. doi:10.1016/j.neuchi.2017.03.001.
8. Szmuda, T., et al., Extent of anterior clinoidectomy for clipping of carotid-ophthalmic aneurysms predicted on three-dimensional computerised tomography angiography. Neurol Neurochir Pol, 2020. 54(2): p. 138-149. Accessed December 5, 2025. https://journals.viamedica.pl/neurologia_neurochirurgia_polska/article/view/66044.
9. de Oliveira E, Tedeschi H, Siqueira MG, Peace DA. The pretemporal approach to the interpeduncular and petroclival regions. Acta Neurochir (Wien). 1995; 136(3-4): 204-211. doi:10.1007/BF01410627.
10. Youssef AS, Abdel Aziz KM, Kim EY, Keller JT, Zuccarello M, van Loveren HR. The carotid-oculomotor window in exposure of upper basilar artery aneurysms: a cadaveric morphometric study. Neurosurgery. 2004; 54(5): 1181-1187; discussion 1187-1189. doi:10.1227/01.neu.0000119757.28390.98.
11. Al-Mefty O. Clinoidal meningiomas. J Neurosurg. 1990; 73(6): 840-849. doi:10.3171/jns.1990.73.6.0840.
12. Day JD. Cranial base surgical techniques for large sphenocavernous meningiomas: technical note. Neurosurgery. 2000; 46(3): 754-759; discussion 759-760. doi:10.1097/00006123-200003000-00046.
13. Dolenc V. Direct microsurgical repair of intracavernous vascular lesions. J Neurosurg. 1983; 58(6): 824-831. doi:10.3171/jns.1983.58.6.0824.
14. Holl DC, Hardillo JAU, Dammers R, van der Schroeff MP, van der Lugt A. Cystic Degeneration of Craniofacial Fibrous Dysplasia. World Neurosurg. 2018; 120: 159-162. doi:10.1016/j.wneu.2018.08.175.
15. Chen YR, Fairholm D. Fronto-orbito-sphenoidal fibrous dysplasia. Ann Plast Surg. 1985; 15(3): 190-203. doi:10.1097/00000637-198509000-00002.
16. Giammattei L, Starnoni D, Levivier M, Messerer M, Daniel RT. Surgery for Clinoidal Meningiomas: Case Series and Meta-Analysis of Outcomes and Complications. World Neurosurg. 2019;129:e700-e717. doi:10.1016/j.wneu.2019.05.253
17. Kamide T, Burkhardt JK, Tabani H, Safaee MM, Lawton MT. Preoperative Prediction of the Necessity for Anterior Clinoidectomy During Microsurgical Clipping of Ruptured Posterior Communicating Artery Aneurysms. World Neurosurg. 2018; 109: e493-e501. doi:10.1016/j.wneu.2017.10.007.
18. Colli BO, Carlotti CG, Assirati JA, Abud DG, Amato MCM, Dezena RA. Results of microsurgical treatment of paraclinoid carotid aneurysms. Neurosurg Rev. 2013; 36(1): 99-114; discussion 114-115. doi:10.1007/s10143-012-0415-0.