Surgical Relevance of Pediatric Anterior Clinoid Process Maturation for Anterior Skull Base Approaches

2020 ◽  
Author(s):  
Robert C Rennert ◽  
Michael G Brandel ◽  
Jeffrey A Steinberg ◽  
Joel R Martin ◽  
David D Gonda ◽  
...  
Keyword(s):  
Skull Base ◽  
Age Groups ◽  
Anatomical Variations ◽  
Anterior Skull Base ◽  
High Resolution Computed Tomography ◽  
Anterior Clinoid Process ◽  
Patients Âgés ◽  
Optic Strut ◽  
Computed Tomography Scans ◽  
Remodeling Pattern

Abstract BACKGROUND Removal of the anterior clinoid process (ACP) can expand anterior skull base surgical corridors. ACP development and anatomical variations are poorly defined in children. OBJECTIVE To perform a morphometric analysis of the ACP during pediatric maturation. METHODS Measurements of ACP base thickness (ACP-BT), midpoint thickness (ACP-MT), length (ACP-L), length from optic strut to ACP tip (ACP-OS), pneumatization (ACP-pneumo), and the presence of an ossified carotico-clinoid ligament (OCCL) or interclinoid ligament (OIL) were made from high-resolution computed-tomography scans from 60 patients (ages 0-3, 4-7, 8-11 12-15, 16-18, and >18 yr). Data were analyzed by laterality, sex, and age groups using t-tests and linear regression. RESULTS There were no significant differences in ACP parameters by laterality or sex, and no significant growth in ACP-BT or ACP-MT during development. From ages 0-3 yr to adult, mean ACP-L increased 49%, from 7.7 to 11.5 mm. The majority of ACP-L growth occurred in 2 phases between ages 0-3 to 8-11 and ages 16-18 to adult. Conversely, ACP-OS was stable from ages 0-3 to 8-11 but increased by 63% between ages 8-11 to adult. Variations in ACP morphology (OCCL/OIL/ACP-pneumo) were found in 15% (9/60) of scans. OCCL and OIL occurred in patients as young as 3 yrs, whereas ACP-pneumo was not seen in patients younger than 11 yrs. CONCLUSION The ACP demonstrates stable thickness and a complex triphasic elongation and remodeling pattern with development, the understanding of which may facilitate removal in patients <12. Clinically relevant ACP anatomic variations can occur at any age.

Bilateral Choanal Atresia Associated with Malformation of the Anterior Skull Base: Embryogenesis and Clinical Implications

1992 ◽  
Vol 101 (11) ◽  
pp. 916-919 ◽  
Author(s):  
Michael E. Dunham ◽  
Robert P. Miller
Keyword(s):  
Skull Base ◽  
Choanal Atresia ◽  
Three Dimensional ◽  
Anterior Skull Base ◽  
Preoperative Imaging ◽  
Clinical Implications ◽  
High Resolution Computed Tomography ◽  
Ethmoid Bone ◽  
Intracranial Complications ◽  
Skull Base Defect

A number of craniofacial and systemic malformations have been described in association with choanal atresia. We report a case of bilateral choanal atresia associated with congenital absence of the cribriform plate, crista galli, and perpendicular plate of the ethmoid bone. The anterior skull base defect was detected by using high-resolution computed tomography with three-dimensional reconstructions. The findings support the mesodermal flow theory of choanal atresia, in which there is excess migration of neural crest cells into the developing nasal septum and posterior choanae. This occurs at the expense of cells that would otherwise form the rest of the ethmoid complex. Clinical implications include the need for adequate preoperative imaging of the anterior skull base and consideration of potential intracranial complications during surgical repair.

Anatomical variations in pneumatization of the anterior clinoid process

2007 ◽  
Vol 106 (1) ◽  
pp. 170-174 ◽  
Author(s):  
Takeshi Mikami ◽  
Yoshihiro Minamida ◽  
Izumi Koyanagi ◽  
Takeo Baba ◽  
Kiyohiro Houkin
Keyword(s):  
Computed Tomography ◽  
Anatomical Variations ◽  
Statistical Dependence ◽  
Multidetector Row Computed Tomography ◽  
Type I ◽  
Anterior Clinoid Process ◽  
Anterior Clinoidectomy ◽  
Computed Tomography Scans ◽  
Preoperative Ct ◽  
Cerebrospinal Fluid Leaks

Object An anterior clinoidectomy can provide enormous benefits, facilitating the management of paraclinoid and upper basilar artery lesions, but it also carries the potential risk of cerebrospinal fluid leaks. The aim of this study was to assess the variation in the pneumatization of the anterior clinoid process (ACP) in an attempt to reduce the complications associated with an anterior clinoidectomy. Methods The authors analyzed the anatomical variations in the pneumatization of the ACP and optical strut (OS) in 600 sides of 300 consecutive patients by using multidetector-row computed tomography (CT). Computed tomography scans with a 0.5-mm thickness were obtained, and coronal and sagittal reconstructions of the images were displayed in all cases. Pneumatization of the ACP was found in 9.2% of all sides. The origin of pneumatization was the sphenoid sinus in 81.8% of all the sides, the ethmoid sinus in 10.9%, and both of these sinuses in 7.3%. Pneumatized patterns were divided into three groups according to the route: 74.5% were Type I, in which pneumatization occurred via the OS; 14.5% were Type II, pneumatization via the anterior root (AR); and 10.9% were Type III, pneumatization via both the OS and the AR. The origin of pneumatization and the pneumatization pattern showed statistical dependence (p < 0.001). Pneumatization of the OS beyond its narrowest point was found in 6.8% of all sides. Conclusions An awareness of the different variations in pneumatization can prevent destruction of the mucous membrane and facilitate orientation during reconstruction with cranialization. During an anterior clinoidectomy, preoperative CT assessments are necessary to evaluate pneumatization of the ACP.

scholarly journals Defining the lateral limits of the endoscopic endonasal transtuberculum transplanum approach: anatomical study with pertinent quantitative analysis

2019 ◽  
Vol 130 (3) ◽  
pp. 848-860 ◽  
Author(s):  
Alberto Di Somma ◽  
Jorge Torales ◽  
Luigi Maria Cavallo ◽  
Jose Pineda ◽  
Domenico Solari ◽  
...  
Keyword(s):  
Skull Base ◽  
Anterior Skull Base ◽  
Ct Scans ◽  
Lateral Extension ◽  
Anterior Clinoid Process ◽  
Endoscopic Endonasal ◽  
Bone Removal ◽  
Skull Base Lesions ◽  
Lateral Portion ◽  
Planum Sphenoidale

OBJECTIVEThe extended endoscopic endonasal transtuberculum transplanum approach is currently used for the surgical treatment of selected midline anterior skull base lesions. Nevertheless, the possibility of accessing the lateral aspects of the planum sphenoidale could represent a limitation for such an approach. To the authors’ knowledge, a clear definition of the eventual anatomical boundaries has not been delineated. Hence, the present study aimed to detail and quantify the maximum amount of bone removal over the planum sphenoidale required via the endonasal pathway to achieve the most lateral extension of such a corridor and to evaluate the relative surgical freedom.METHODSSix human cadaveric heads were dissected at the Laboratory of Surgical NeuroAnatomy of the University of Barcelona. The laboratory rehearsals were run as follows: 1) preliminary predissection CT scans, 2) the endoscopic endonasal transtuberculum transplanum approach (lateral limit: medial optocarotid recess) followed by postdissection CT scans, 3) maximum lateral extension of the transtuberculum transplanum approach followed by postdissection CT scans, and 4) bone removal and surgical freedom analysis (a nonpaired Student t-test). A conventional subfrontal bilateral approach was used to evaluate, from above, the bone removal from the planum sphenoidale and the lateral limit of the endonasal route.RESULTSThe endoscopic endonasal transtuberculum transplanum approach was extended at its maximum lateral aspect in the lateral portion of the anterior skull base, removing the bone above the optic prominence, that is, the medial portion of the lesser sphenoid wing, including the anterior clinoid process. As expected, a greater bone removal volume was obtained compared with the approach when bone removal is limited to the medial optocarotid recess (average 533.45 vs 296.07 mm2; p < 0.01). The anteroposterior diameter was an average of 8.1 vs 15.78 mm, and the laterolateral diameter was an average of 18.77 vs 44.54 mm (p < 0.01). The neurovascular contents of this area were exposed up to the insular segment of the middle cerebral artery. The surgical freedom analysis revealed a possible increased lateral maneuverability of instruments inserted in the contralateral nostril compared with a midline target (average 384.11 vs 235.31 mm2; p < 0.05).CONCLUSIONSBone removal from the medial aspect of the lesser sphenoid wing, including the anterior clinoid process, may increase the exposure and surgical freedom of the extended endoscopic endonasal transtuberculum transplanum approach over the lateral segment of the anterior skull base. Although this study represents a preliminary anatomical investigation, it could be useful to refine the indications and limitations of the endoscopic endonasal corridor for the surgical management of skull base lesions involving the lateral portion of the planum sphenoidale.

scholarly journals The Relationship of High Septal Deviation, the Depth of Olfactory Fossa, and Gera Angle: Is High Septal Deviation Associated With Any Anatomic Abnormalities in the Anterior Skull Base?

2020 ◽  
pp. 014556132092640
Author(s):  
Zeynep Onerci Altunay ◽  
T. Metin Onerci
Keyword(s):  
Computed Tomography ◽  
Skull Base ◽  
Anterior Skull Base ◽  
Septal Deviation ◽  
Computed Tomography Scans ◽  
Relationship Of ◽  
The Relationship

Objective: To investigate the association of high septal deviation with the olfactory fossa depth and Gera angle. Methods: Fifty-four computed tomography scans of patients with high septal deviation were evaluated. The olfactory fossa depth and Gera angle were measured. The values of the deviated and nondeviated sides were compared. Results: No association between high septal deviation and the olfactory fossa depth and Gera angle was found. Conclusion: High septal deviation does not affect the olfactory fossa depth and Gera angle. In other words, the olfactory fossa depth and Gera angle have no association with the high septal deviation.

Anatomical variations of anterior ethmoidal artery at the ethmoidal roof and anterior skull base in Asians

2018 ◽  
Vol 41 (5) ◽  
pp. 543-550 ◽  
Author(s):  
Baharudin Abdullah ◽  
Eng Haw Lim ◽  
Hazama Mohamad ◽  
Salina Husain ◽  
Mohd Ezane Aziz ◽  
...  
Keyword(s):  
Skull Base ◽  
Anatomical Variations ◽  
Anterior Skull Base ◽  
Ethmoidal Artery ◽  
Anterior Ethmoidal Artery

scholarly journals Sella turcica bridging and ossified carotico-clinoid ligament: Correlation with sex and age

2018 ◽  
Vol 31 (3) ◽  
pp. 299-304 ◽  
Author(s):  
Daniele Gibelli ◽  
Michaela Cellina ◽  
Stefano Gibelli ◽  
Marta Panzeri ◽  
Antonio Giancarlo Oliva ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Surgical Procedures ◽  
Age Groups ◽  
Sella Turcica ◽  
Anterior Clinoid Process ◽  
Computed Tomography Scans ◽  
The Mean ◽  
Age And Sex

Aim Sella turcica bridging and ossified carotico-clinoid ligament are two variants of the sella turcica, the origin of which is partially unknown. These variations should be properly recognised, as they may hamper the removal of the anterior clinoid process in surgical procedures. Therefore, our aim was to determine the prevalence of these two anatomical variants and to investigate their prevalence according to patient sex and age in a series of maxilla computed tomography scans. Materials and methods We revised 300 computed tomography scans of the head from northern Italian patients, stratified into three age groups (18–40 years, 41–60 years, >60 years): a logistic regression analysis was used to explore an association of sella turcica bridging with age and sex through Matlab software, also including a test for the extracted model ( P < 0.05). Results The mean prevalence of sella turcica bridging and ossified carotico-clinoid ligament were 0.16 ± 0.06 (48/300, 16.0%) and 0.09 ± 0.03 (26/300, 8.7%), respectively. Statistically significant differences according to sex were found neither for sella turcica bridging ( P = 0.345) nor for ossified carotico-clinoid ligament ( P = 0.412). Only sella turcica bridging showed a correlation with age ( P = 0.007). In addition, the two variants were often associated, as patients without sella turcica bridging usually did not show ossified carotico-clinoid ligament ( P < 0.001). Discussion Our results suggest an association between the two variants, and provide a novel contribution to the debate around their origin.

scholarly journals Preoperative Computed Tomography Imaging of the Sphenoid Sinus: Striving Towards Safe Transsphenoidal Surgery

2019 ◽  
Vol 81 (03) ◽  
pp. 251-262
Author(s):  
John Raseman ◽  
Melike Guryildirim ◽  
André Beer-Furlan ◽  
Miral Jhaveri ◽  
Bobby A. Tajudeen ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Transsphenoidal Surgery ◽  
Sphenoid Sinus ◽  
Medical Center ◽  
Tumor Resection ◽  
Anatomical Variations ◽  
High Resolution Computed Tomography ◽  
Anterior Clinoid Process ◽  
Local Bone ◽  
Preoperative Ct

Introduction Preoperative high-resolution computed tomography (HRCT) is essential in patients undergoing transsphenoidal surgery to identify potential high-risk anatomic variations. There is no consensus in the literature, as to which grading system to use to describe these variants, leading to inconsistent terminology between studies. In addition, substantial variability exists in the reported incidence of anatomic variants. In this study, we performed an institutional imaging analysis and literature review with the objective of consolidating and clearly defining these sphenoid sinus anatomical variations. In addition, we highlighted their surgical implications and propose a checklist for a systematic assessment of the sphenoid sinus on preoperative CT. Methods Review of the literature and retrospective analysis assessing several imaging parameters in 81 patients who underwent preoperative HRCT imaging for endoscopic transsphenoidal tumor resection from January 2008 through July 2015 at Rush University Medical Center. Results The most common sphenoid pneumatization patterns were sellar (45%) and postsellar (49%) types. Anterior clinoid process (ACP) pneumatization was seen in 17% of patients with high concordance of ipsilateral optic nerve (ON) protrusion. ON protrusion and dehiscence was present in 17 and 6% of patients, respectively. Internal carotid artery (ICA) protrusion and dehiscence was present in 30 and 5% of patients, respectively. Dehiscence rates from local bone invasion overlying the ICA and ON occurred in 17 and 4% of cases, respectively. Conclusions Our study highlights and reviews the key variants that have potential to impact surgical complications and outcomes in a heterogeneous patient population. The proposed preoperative CT checklist for patients, undergoing transsphenoidal surgery, consistently identifies these higher risk anatomical variants.

scholarly journals Evaluating the frequency of anatomical variations of the sinonasal region in pediatric and adult age groups according to gender: computed tomography findings of 1532 cases

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Adem Bora ◽  
Merve Koç ◽  
Kasım Durmuş ◽  
Emine Elif Altuntas
Keyword(s):  
Computed Tomography ◽  
Age Groups ◽  
Anatomical Variations ◽  
Concha Bullosa ◽  
Anterior Clinoid Process ◽  
Age And Gender ◽  
Adult Age ◽  
Septum Deviation ◽  
Significant Difference ◽  
And Gender

Abstract Background The aim of the present study was to evaluate retrospectively the frequency of anatomical variations in sinonasal region, which were frequently seen in our cases, for whom coronal section paranasal computed tomography imaging (CPNCT) was taken, as well as the correlation of these variations with age and gender and correlations of identified anatomical variations with one another. In the study, CBCT scans of a total of 1532 (825 males and 707 females) cases were evaluated in order to determine the prevalence of anatomical variations of the nasal cavity and paranasal sinuses. All the images were taken by a multi-detector CT device (Aquilion, Toshiba medical system, Tokyo, Japan). Results Most frequently detected three anatomical variations were septum deviation (79.7%), concha bullosa (40.9%), and ethmoid bulla (21.0%) according to the frequency order. When the frequency of anatomical variations was evaluated according to gender, septum deviation, concha bullosa, and anterior clinoid process pneumatization were more frequently observed in males and Onodi cell in females (p < 0.05). When the relationships of the anatomical variations with one another were evaluated, it was found that the possibility of the presence of concha bullosa in the septum deviation cases and the presence of ethmoid bulla in the cases with Haller cell septum were higher (p < 0.05). In terms of the anatomical variations that were evaluated by taking age as the independent variable, a statistically significant difference was observed in pterygoid process pneumatization, Haller cell, pneumatized crista galli, ethmoid bulla, and paradoxical middle concha between the adult and children age groups (p < 0.05). Conclusion In terms of the frequency of occurrence to various sinonasal region variations, statistically significant differences were observed between both genders and age groups. The correlations of the detected variations with each other were also remarkable. Consequently, it is believed that comprehensive studies and serious objective evaluations evaluating the change of frequency of anatomical variations according to age and gender besides their correlation with each other are required.

Extradural anterior clinoidectomy

2005 ◽  
Vol 102 (5) ◽  
pp. 945-950 ◽  
Author(s):  
Akio Noguchi ◽  
Vijayabalan Balasingam ◽  
Yoshiaki Shiokawa ◽  
Sean O. McMenomey ◽  
Johnny B. Delashaw
Keyword(s):  
Skull Base ◽  
Basilar Artery ◽  
Anatomical Variations ◽  
Anterior Clinoid Process ◽  
Content Type ◽  
Anterior Clinoidectomy ◽  
Small Structure ◽  
Surgical Field ◽  
The Brain ◽  
Fine Print

✓ The anterior clinoid process (ACP), located on the skull base, is a relatively small structure, although its removal provides enormous gain in facilitating the management of lesions—either tumors or aneurysms—in the paraclinoid region and upper basilar artery. The extensive surgical field gained contributes to safer exposure of the neurovascular elements in the vicinity while avoiding excessive and hazardous retraction of the brain. In this report the authors present a technically simpler avenue for performing an extradural anterior clinoidectomy after reviewing the anatomy of the ACP and its anatomical variations. Additionally, the original Dolenc procedure and its subsequent derivatives are compared and contrasted to the authors' simpler and less laborious technique. Different clinical situations in which to use the procedure are described based on the authors' experience from 60 cases (40 aneurysm cases and 20 tumor cases) during a 4-year period.

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