• Sebastian Anibal Alejandro, Juan Pablo Carrasco-Hernández, Marcos Devanir S da Costa, Danilo Santos Ferreira, Lima Joao Vitor Fernandes JVF Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, São Paulo, Brazil., Bruno Loof de Amorim, Juan Alberto Paz-Archila, and Feres Chaddad-Neto.
• Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, São Paulo, Brazil.
• World Neurosurg. 2021 Feb 1; 146: 217-231.

ObjectiveAnterior clinoidectomy is an important and essential skill for skull base and cerebrovascular neurosurgeons. We present a 1-piece intradural anterior clinoidectomy, providing a step-by-step description of the technique, independently of anatomic variations.MethodsBetween 2014 and 2020, 128 patients (119 women and 9 men; average age, 54.6 years) underwent intradural anterior clinoidectomy during microsurgical clipping of carotid-ophthalmic aneurysms.ResultsThe anterior clinoid process continues medially with the planum sphenoidale, over the optic nerve, laterally with the lesser wing of the sphenoid bone, and inferiorly with the optic strut, which is always found anteriorly to the clinoid segment of the internal carotid artery, and separates the optic canal from the superior orbital fissure. The proposed anterior clinoidectomy followed, one after the other, these 3 fixation points for the detachment of the anterior clinoid process. The main indication for intradural anterior clinoidectomy was the management of vascular lesions around paraclinoid (clinoidal and ophthalmic) segments of the internal carotid artery. Complications of the procedure included injury to the internal carotid artery or the ophthalmic artery, thermal damage to the optic nerve, and invasion of the sphenoid sinus or a pneumatized anterior clinoid process, which could lead to postoperative cerebrospinal fluid leakage.ConclusionsThe anterior clinoidectomy technique described here minimizes the drilling surface for detachment of the anterior clinoid process and reduces operative time as well as the amount of bone dust produced by drilling. It also precisely delineates the localization of the optic strut, preventing carotid or optic nerve damage.Copyright © 2020 Elsevier Inc. All rights reserved.

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