Ultrasonic bone curettage for optic canal unroofing and anterior clinoidectomy

2006 ◽  
Vol 104 (4) ◽  
pp. 621-624 ◽  
Author(s):  
Han Soo Chang ◽  
Masahiro Joko ◽  
Joon Suk Song ◽  
Kiyoshi Ito ◽  
Tatsushi Inoue ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Visual Outcome ◽  
Optic Canal ◽  
Internal Auditory Meatus ◽  
Major Morbidity ◽  
Anterior Clinoidectomy ◽  
Optic Nerve Damage ◽  
Bone Removal ◽  
Visual Status ◽  
Optic Canal Unroofing

✓Extradural unroofing of the optic canal and subsequent mobilization of the optic nerve is a useful technique in the surgical treatment of parasellar tumors; however, the drilling procedure itself is associated with the risk of optic nerve damage. A safer technique would certainly be beneficial. The ultrasonic bone curette is a device developed in Japan for safer bone removal. Its use in intradural anterior clinoidectomy and opening of the internal auditory meatus has been reported before. In this article the authors describe their experience in using this device for extradural unroofing of the optic canal in patients with parasellar tumors. Between March 2002 and November 2004, the aforementioned technique was used in the treatment of eight patients with parasellar tumors. After undertaking a frontotemporal craniotomy and orbital osteotomy, an ultrasonic bone curette was used to unroof the optic canal via an epidural approach; in five cases anterior clinoidectomy was added subsequently. Using an ultrasonic bone curette, unroofing of the optic canal was completed safely and required much less expertise than that required for standard drilling. The mortality and major morbidity rates were 0%. The visual function outcome was satisfactory, with the overall visual status improving in all seven patients in whom this symptom was present preoperatively. The ultrasonic bone curette makes the unroofing of the optic canal safer and easier, possibly improving the visual outcome of patients undergoing surgery for parasellar tumors.

scholarly journals Extradural anterior clinoidectomy in surgical management of clinoidal meningiomas

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
K. El-Bahy ◽  
Ashraf M. Ibrahim ◽  
Ibrahim Abdelmohsen ◽  
Hatem A. Sabry
Keyword(s):  
Cavernous Sinus ◽  
Tumor Resection ◽  
Visual Outcome ◽  
Extent Of Resection ◽  
Optic Canal ◽  
Falciform Ligament ◽  
Cavernous Sinus Invasion ◽  
Anterior Clinoidectomy ◽  
Microsurgical Techniques

Abstract Background Despite the recent advances in skull base surgery, microsurgical techniques, and neuroimaging, yet surgical resection of clinoidal meningiomas is still a major challenge. In this study, we present our institution experience in the surgical treatment of anterior clinoidal meningiomas highlighting the role of extradural anterior clinoidectomy in improving the visual outcome and the extent of tumor resection. This is a prospective observational study conducted on 33 consecutive patients with clinoidal meningiomas. The surgical approach utilized consisted of extradural anterior clinoidectomy, optic canal deroofing with falciform ligament opening in all patients. The primary outcome assessment was visual improvement and secondary outcomes were extent of tumor resection, recurrence, and postoperative complications. Results The study included 5 males and 28 females with mean age 49.48 ± 11.41 years. Preoperative visual deficit was present in 30 (90.9%) patients. Optic canal involvement was present in 24 (72.7%) patients, ICA encasement was in 16 (48.5%), and cavernous sinus invasion in 8 (24.2%). Vision improved in 21 patients (70%), while 6 patients (20%) had stationary course and 1 patient (3%) suffered postoperative new visual deterioration. Gross total resection was achieved in 24 patients (72.7%). The main factors precluding total removal were cavernous sinus involvement and ICA encasement. Mortality rate was 6.1%; mean follow-up period was 27 ± 13 months. Conclusions In this series, the use of extradural anterior clinoidectomy provided a favorable visual outcome and improved the extent of resection in clinoidal meningioma patients.

Visual Outcome of Tuberculum Sellae Meningiomas after Extradural Optic Nerve Decompression

Neurosurgery ◽  
2006 ◽  
Vol 59 (3) ◽  
pp. 570-576 ◽  
Author(s):  
Tiit Mathiesen ◽  
Lars Kihlström
Keyword(s):  
Cerebrospinal Fluid ◽  
Optic Nerve ◽  
Diabetes Insipidus ◽  
Visual Outcome ◽  
Optic Canal ◽  
Visual Deterioration ◽  
Nerve Decompression ◽  
Visual Outcomes ◽  
Tuberculum Sellae

Abstract OBJECTIVE: Meningiomas of the tuberculum sellae have a close relationship with the optic apparatus. Even modern series show a 10 to 20% risk of visual deterioration after surgery. We have attempted to improve visual outcome by extradural decompression of the optic canal and anterior clinoid process, followed by intradural release of the optic nerve; this study provides an analysis of visual outcomes with this approach. METHODS: Treatment, histopathology, and follow-up data of 29 consecutive patients undergoing surgery for tuberculum sellae meningiomas with initial release of the optic nerve were prospectively collected. RESULTS: Radical tumor removal was possible in all 23 patients with primary tumors and in three out of six patients with recurrent tumors. All patients but two of the worst affected with preoperative visual compromise improved from surgery; there were no instances of visual deterioration. Five patients with normal preoperative vision remained intact and visual improvement was 22 (91%) out of 24 patients in the remaining patients. In total, 13 patients (42%) had completely normal vision at follow-up. Mainly patients younger than 60 years experienced complete normalization after surgery. Two patients underwent transsphenoidal surgery for cerebrospinal fluid leaks. Postoperative endocrinological symptoms were temporary diabetes insipidus in one patient and permanent diabetes insipidus in another patient undergoing elective sectioning of the pituitary stalk because of a recurrent tumor with invasive growth into the stalk. CONCLUSION: Adding early optic nerve decompression by extradural clinoidectomy and optic canal unroofing to a frontopterional approach seemed to improve visual outcomes because there were no instances of visual deterioration. Simpson Grade 1 to 2 removal was possible in all patients with primary surgery, whereas recurrent cases could only be treated with lower grades of radicality. Radical removal, however, required readiness to reoperate for cerebrospinal fluid leakage at the site of the drilled tumor origin in bone.

Fracture line in post head injury optic nerve damage

1991 ◽  
Vol 105 (3) ◽  
pp. 203-204 ◽  
Author(s):  
Sadhana R. Nayak ◽  
M. V. Kirtane ◽  
M. V. Ingle
Keyword(s):  
Optic Nerve ◽  
Head Injury ◽  
Blunt Trauma ◽  
Head Injuries ◽  
Nerve Damage ◽  
Fracture Line ◽  
Optic Canal ◽  
Optic Nerve Damage

AbstractDiminution of vision following head injuries involving the optic canal is not uncommon. In order to find how a blunt trauma to the frontotemporal region produced damage to the optic nerve inits canalicular this study was conducted on cadaveric skulls and its results are described.

Extradural Anterior Clinoidectomy as an Alternative Approach for Optic Nerve Decompression: Anatomic Study and Clinical Experience

2006 ◽  
Vol 59 (suppl_4) ◽  
pp. ONS-253-ONS-262 ◽  
Author(s):  
Yang Yang ◽  
Hongjie Wang ◽  
Yi Shao ◽  
Zenghua Wei ◽  
Shugan Zhu ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Optic Neuropathy ◽  
Optic Canal ◽  
Falciform Ligament ◽  
Traumatic Optic Neuropathy ◽  
Pterional Craniotomy ◽  
Anterior Clinoidectomy ◽  
Nerve Decompression ◽  
Optic Nerve Decompression ◽  
Alternative Approach

Abstract OBJECTIVE: We introduce pterional craniotomy extradural anterior clinoidectomy as a new alternative approach for optic nerve decompression in patients with traumatic optic neuropathy. METHODS: Intracranial structures pertinent to pterional craniotomy extradural anterior clinoidectomy were carefully studied in 10 dry craniums and 10 cranial bases with dura mater. Important parameters of these structures were measured. Stepwise dissections simulating pterional craniotomy extradural anterior clinoidectomy were performed in 20 cadaver heads bilaterally. Pterional craniotomy extradural anterior clinoidectomy was then applied to 12 patients (13 eyes) with traumatic optic neuropathy and severe visual dysfunction. RESULTS: The anatomic features and their variations of optic canal, ophthalmic artery, falciform ligament, and Zinn's ring (annular tendon) were studied and measured in detail. Extensive opening of the optic canal and optic nerve sheath was successfully achieved in all 12 patients without major surgical complications. Significant visual acuity improvement occurred in eight (nine eyes) out of our 12 patients after surgery. The surgical techniques and advantages of pterional craniotomy extradural anterior clinoidectomy for optic nerve decompression are presented and discussed in detail. @@CONCLUSION:@@ Pterional craniotomy extradural anterior clinoidectomy is a promising new alternative approach for optic nerve decompression in patients with traumatic optic neuropathy.

EFFECT OF EARLY OPTIC CANAL UNROOFING ON THE OUTCOME OF VISUAL FUNCTIONS IN SURGERY FOR MENINGIOMAS OF THE TUBERCULUM SELLAE AND PLANUM SPHENOIDALE

Neurosurgery ◽  
2008 ◽  
Vol 62 (4) ◽  
pp. 839-846 ◽  
Author(s):  
Kazuhiko Nozaki ◽  
Ken-ichiro Kikuta ◽  
Yasushi Takagi ◽  
Youhei Mineharu ◽  
Jun A. Takahashi ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Tumor Size ◽  
Tumor Resection ◽  
Optic Canal ◽  
Visual Symptoms ◽  
Tuberculum Sellae ◽  
The Mean ◽  
Planum Sphenoidale ◽  
Tumor Consistency ◽  
Optic Canal Unroofing

Abstract OBJECTIVE The aim of this study was to evaluate the effect of early optic canal unroofing on visual function in patients with meningiomas of the tuberculum sellae and planum sphenoidale. METHODS We retrospectively reviewed the clinical records of 20 consecutive patients with tuberculum sellae meningiomas and two patients with planum sphenoidale meningiomas who were admitted to our institution from 1999 to 2007. Factors that may influence postoperative visual functions were analyzed, including patient's age and sex, duration of preoperative visual symptoms, preoperative visual acuity, tumor size, tumor consistency, tumor extension into the optic canal, tumor adhesion to the optic nerve, timing of optic canal unroofing, and tumor resection rate. RESULTS The mean patient age was 52.9 ± 13.7 years (range, 27–73 yr); 18 patients were women and four were men. The mean maximum tumor size was 2.3 ± 0.7 cm (range, 1.5–3.5 cm). Visual symptoms were present preoperatively in 19 patients, and three patients were asymptomatic. The mean duration of visual symptoms was 12.0 ± 16.4 months (range, 0–72 mo). Tumor resection was evaluated according to Simpson's grade, and Grade II was achieved in 14, Grade III in two, and Grade IV in six (two patients were recurrent cases). Tumors were extended into the optic canal in 15 patients, and severe adhesion to the optic nerve was observed in nine patients. Tumor consistency was soft in eight patients, intermediate in eight patients, and hard in six patients. The optic canal was unroofed early before dissection or manipulation of tumor in nine patients (early group) and after dissection of tumor in seven patients (late group), and optic canal unroofing was not performed in six patients (none group; no canal extension in two and intentional incomplete resection in four patients). Visual symptoms were improved in 10 patients, unchanged in seven patients, and worsened in five patients (transient in two and permanent in three). Logistic regression analysis revealed that early optic canal unroofing was an independent factor for postoperative improvement of visual symptoms. CONCLUSION Early optic canal unroofing may increase the possibility of improved preoperative visual symptoms in surgical resection of tuberculum sellae meningiomas and planum sphenoidale meningiomas.

Surgical management of meningiomas involving the optic nerve sheath

2004 ◽  
Vol 101 (6) ◽  
pp. 951-959 ◽  
Author(s):  
Uta Schick ◽  
Uwe Dott ◽  
Werner Hassler
Keyword(s):  
Optic Nerve ◽  
Postoperative Radiotherapy ◽  
Visual Outcome ◽  
Tumor Location ◽  
Optic Nerve Sheath ◽  
Optic Canal ◽  
Content Type ◽  
Nerve Sheath ◽  
Fine Print

Object. The management of optic nerve sheath meningiomas (ONSMs) remains controversial but includes surgery, radiotherapy, and plain observation. Surgery is often thought to result in postoperative blindness. The authors report on a large series of patients surgically treated for ONSM, with an emphasis on the visual outcome. Methods. Seventy-three patients with ONSMs who had undergone surgery between 1991 and 2002 were retrospectively analyzed. The standard surgical approach consisted of pterional craniotomy, intradural (54 patients) or extradural (10 patients) unroofing of the optic canal, or a combined procedure (seven patients). Thirty-two tumors demonstrated extension through the optic canal. Twenty-nine tumors reached the chiasm or contralateral side. Patients with intraorbital flat tumors should undergo radiotherapy instead of surgery. Those with a large intraorbital mass and no useful vision should undergo surgery. Tumors extending intracranially through the optic canal are amenable to decompression of the optic canal and resection of the intracranial portion. The follow-up period was a mean 45.4 months (range 6–144 months). Ten patients underwent postoperative radiotherapy. Visual acuity was not significantly influenced by surgery but did become worse with a longer duration of preoperative symptoms and a longer follow-up period. A tumor location in the optic canal was another negative factor. Radiotherapy preserved vision in five of 10 cases. Conclusions. The loss of vision in patients with ONSM is only a matter of time. In patients with good vision the role of radiotherapy becomes more important. Surgery is recommended for intracranial tumors to prevent contralateral extension.

scholarly journals Optic Foraminotomy for Clipping of Superior Carotid-Ophthalmic Aneurysms

2021 ◽  
Vol 8 ◽  
Author(s):  
Matias Baldoncini ◽  
Sabino Luzzi ◽  
Alice Giotta Lucifero ◽  
Ana Flores-Justa ◽  
Pablo González-López ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Carotid Artery ◽  
Surgical Techniques ◽  
Visual Outcome ◽  
Current Approach ◽  
Direct Access ◽  
Anterior Clinoid Process ◽  
Anterior Clinoidectomy ◽  
Transsylvian Approach ◽  
Secondary Objective

Background: Carotid-ophthalmic aneurysms usually cause visual problems. Its surgical treatment is challenging because of its anatomically close relations to the optic nerve, carotid artery, ophthalmic artery, anterior clinoid process, and cavernous sinus, which hinder direct access. Despite recent technical advancements enabling risk reduction of this complication, postoperative deterioration of visual function remains a significant problem. Therefore, the goal of preserving and/or improving the visual outcome persists as a paramount concern.Objective: We propose optic foraminotomy as an alternative microsurgical technique for dorsal carotid-ophthalmic aneurysms clipping. As a secondary objective, the step by step of that technique and its benefits are compared to the current approach of anterior clinoidectomy.Methods: We present as an example two patients with superior carotid-ophthalmic aneurysms in which the standard pterional craniotomy, transsylvian approach, and optic foraminotomy were performed. Surgical techniques are presented and discussed in detail with the use of skull base dissections, microsurgical images, and original drawings.Results: Extensive opening of the optic canal and optic nerve sheath was successfully achieved in all patients allowing a working angle with the carotid artery for correct visualization of the aneurysm and further clipping. Significant visual acuity improvement occurred in both patients because of decompression of the optic nerve.Conclusion: Optic foraminotomy is an easy and recommended technique for exposing and treating superior carotid-ophthalmic aneurysms and allowing optic nerve decompression during the first stages of the procedure. It shows several advantages over the current anterior clinoidectomy technique regarding surgical exposure and facilitating visual improvement.

scholarly journals Extradural clinoidectomy for resection of clinoidal meningioma

2017 ◽  
Vol 43 (videosuppl2) ◽  
pp. V10 ◽  
Author(s):  
Simon Buttrick ◽  
Jacques J. Morcos ◽  
Mohamed S. Elhammady ◽  
Anthony C. Wang
Keyword(s):  
Optic Nerve ◽  
Optic Canal ◽  
Superior Orbital Fissure ◽  
Anterior Clinoid Process ◽  
Anterior Clinoidectomy ◽  
Link Type ◽  
Optic Strut ◽  
Parasellar Region ◽  
Versatile Technique

Extradural anterior clinoidectomy is a versatile technique to increase exposure of the sellar and parasellar region. It is of particular use in the resection of clinoidal meningiomas, as sphenoidal and clinoidal hyperostosis can cause compression of the optic nerve. Extradural clinoidectomy follows a series of steps, consisting of (1) unroofing of the superior orbital fissure, (2) unroofing of the optic canal, (3) removal of the optic strut, and (4) removal of the anterior clinoid process. The authors show these steps in detail, as well as their application to the resection of a large clinoidal meningioma.The video can be found here: https://youtu.be/O1Fcef29ETg.

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