Posterior clinoid process as a landmarker in current endoscopic-assisted neurosurgical approaches

Abstract

Summary Background/Introduction The morphologic variations of posterior clinoid process (PCP) anatomy have rarely been documented in the neurosurgical literature. Purpose(s)/Aim(s) We investigated the PCP in terms of the endoscopic perspective, which will guide surgeons for safely maneuvering within the paraclinoid region and during the transcavernous approach. Methods Four alcohol-immersed cadaveric heads injected with pigmented silicone rubber were prepared for skull base dissections. We evaluated the three-dimensional reconstructed anatomy of PCPs. Bilateral pterional and endonasal transclival approaches were performed. In pterional corridors, we advanced the dissection through the optic-carotid triangle to observe the PCP; whereas in transclival approaches, we applied a transclival route to expose the dorsum sellae and PCP. Two angled (0 and 30°) rigid endoscopes with outer diameters of 4 mm were introduced. By endoscopically viewing the surgical anatomy, the PCP and dorsum sellae were seen with ease in both approaches. Results All of the specimens showed an intact dorsum sellae and both posterior clinoid processes. Morphologic variation was described and recorded in each specimen. The posterior clinoid process is a landmark in important neurosurgical approaches. In our study we described the spatial guidance in either transcranial or transnasal endoscopic routes. Conclusion Taking advantage of the innovative integration of the video processing system, it facilitates the surgeons to work in a limited confined intracranial space. We are convinced that it provides practical information concerning the trans-PCP maneuver.