Anatomical Justification of Extradural Resection of the Anterior Clinoid Process

Albert A. Sufianov, Iurii A. Iakimov, Nargiza A. Garifullina, Rinat A. Sufianov, Roman V. Kovalenko, Idrisdzhoni A. Kosimzoda
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Abstract

Abstract Objective The study aimed to provide neuroanatomical justification of the extradural resection of the anterior clinoid process (ACP). Material and Method Using a cross-sectional study design, 47 cranial computed tomography (CT) scans were examined. There were 31 (65.96%) females aged 28 to 79 years. The measured dimensions were ACP length and width, and optic strut (OS) width. Index (iacp) was measured as the ratio of ACP width to ACP length. The ACP volume and working operating field (WOF) volume were measured using Syngo.via Siemens program. The percentage expansion of WOF after removal of the ACP was estimated on 5 fixed human cadaver heads with the exoscope VITOM 3D. The possibilities of the combined approach were demonstrated in a clinical case. Results The mean ACP lengths were 11.31 ± 2.76 and 11.54 ± 2.86 mm, on the right and left, respectively. The mean ACP widths were 7.70 ± 1.66 and 7.64 ± 1.67 mm, on the right and left, respectively. Average iacp was 0.67 (minimum 0.45; maximum 0.90). The width of the OS varied in the range from 1.37 to 4.75 mm. The average volume of right ACP was 0.71 ± 0.16 cm3, right WOF was 3.26 ± 0.74 cm3, left ACP was 0.71 ± 0.15 cm3, left and WOF was 3.20 ± 0.76 cm3. Removal of the right ACP expanded the right WOF by 22.21 ± 3.88%, and left ACP by 22.78 ± 5.50%. There was an approximately 25% increase in the WOF from the cadaveric dissections. Taking into account the variability of the ACP and OS, we proposed our own surgical classification of complicated (iacp ≥ 0.67; medium OS 2.5 mm ≤ 4.0 mm; wide OS ≥ 4.0 mm; ACP with pneumatization) and uncomplicated ACP (iacp 0.45 ≤ 0.67 mm; iacp ≤ 0.45; narrow OS ≤ 2.5 mm; ACP without pneumatization). Using this classification, we developed an algorithm for ACP dissection and removal. This was piloted in a clinical case of microsurgical clipping of a left internal carotid artery-posterior communicating artery aneurysm via the left minipterional approach. Conclusion Extradural removal of ACP expands the WOF by approximately 25%, it helps neurosurgeons to improve proximal vascular control and avoid complications, and expands the range of indications for neurosurgical interventions in the skull base area.
前斜突硬膜外切除术的解剖学依据
摘要目的为硬膜外切除前斜突(ACP)提供神经解剖学依据。材料和方法采用横断面研究设计,对47张颅脑计算机断层扫描(CT)进行了检查。28 ~ 79岁女性31例,占65.96%。测量尺寸为ACP长度、宽度和光学支柱宽度。指数(iacp)为ACP宽度与ACP长度之比。使用Syngo测量ACP容积和工作工作场(WOF)容积。通过西门子程序。利用VITOM 3D外窥镜对5个固定人头进行ACP切除后WOF的扩张百分比进行估计。在一个临床病例中证明了联合方法的可能性。结果左、右ACP长度分别为11.31±2.76 mm和11.54±2.86 mm。平均左、右ACP宽度分别为7.70±1.66、7.64±1.67 mm。平均iacp为0.67(最小0.45;最大0.90)。操作系统的宽度在1.37 ~ 4.75 mm之间。右侧ACP平均体积0.71±0.16 cm3,右侧WOF平均体积3.26±0.74 cm3,左侧ACP平均体积0.71±0.15 cm3,左侧和WOF平均体积3.20±0.76 cm3。切除右侧ACP使右侧WOF扩大22.21±3.88%,左侧ACP扩大22.78±5.50%。尸体解剖的WOF增加了大约25%。考虑到ACP和OS的可变性,我们提出了自己的复杂手术分类(iacp≥0.67;介质OS 2.5 mm≤4.0 mm;宽OS≥4.0 mm;带气动的ACP)和无并发症ACP (iacp 0.45≤0.67 mm;Iacp≤0.45;窄OS≤2.5 mm;无气动的ACP)。利用这种分类,我们开发了一种ACP解剖和切除算法。这是试点在显微手术夹左颈内动脉-后交通动脉瘤经左小翼入路的临床病例。结论硬膜外切除ACP扩大了约25%的WOF,有助于神经外科医生改善近端血管控制,避免并发症,扩大了颅底区神经外科干预的适应证范围。
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