Extradural clinoidectomy for resection of clinoidal meningioma.

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 .

Low Subfrontal Dural Opening for Anterior Clinoid Meningioma.

Introduction A variety of dural openings are described for frontal-temporal and cranio-orbital craniotomies. As with any surgical technique, the goal is to optimally and safely address the pathology, minimize normal anatomy disruption, and optimize postoperative recovery. This study reports a modified dural opening for frontal-temporal approaches which minimizes brain exposure while facilitating visualization for neoplastic and vascular lesions of the anterior clinoid, supra- and parasellar and adjacent regions. Methods A sample case is presented for which a low subfrontal dural exposure was utilized for tumor resection. The clinical presentation, surgical procedure, and outcome are summarized including a video detailing the surgical technique. Results A 63-year-old female with gradual left eye vision loss and tumor enlargement on serial imaging. The small dural-based tumor arose from the left anterior clinoid and optic canal region compressing the optic nerve. The video shows a left frontal-temporal craniotomy used to perform extradural anterior clinoidectomy and optic canal decompression. The novel low subfrontal dural opening without fixed brain retraction allowed dural opening around the optic canal and clinoidectomy region to resect tumor and complete optic nerve decompression. Postoperatively, the patient did well with significant recovery of vision and follow-up at 2.5 years shows no evidence of tumor recurrence. Conclusion The novel low subfrontal dural opening provides access to lesions of the supra-and para-sellar and adjacent regions, and preservation of much of the dura avoids some of the risks of intradural dissection including Sylvian fissure dissection and brain retraction The link to the video can be found at: https://youtu.be/Jc7wvR4PTFk .