Avci E, Bademci G, Ozturk A
Department of Neurosurgery, School of Medicine, University of Harran, Urfa, Turkey.
Minim Invasive Neurosurg. 2005 Oct;48(5):268-72. doi: 10.1055/s-2005-915595.
The microsurgical and radiological anatomy of the clinoid process were studied to give surgeons more details about the anterior clinoid process and its relations to the vascular and nervous neighbourhood during intradural and extradural clinoidectomy, thus making the operative procedures safer.
Seven formalin-fixed (14 sides) and two fresh cadavers (four sides) were studied to reveal the surgical anatomy of the anterior clinoid process and related landmarks during intradural and extradural drilling techniques of clinoid process. Furthermore, aeration of the anterior clinoid process was investigated in 100 paranasal tomography (200 sides) scans.
Careful drilling of the anterior clinoid process is mandatory to avoid damage to the extremely important adjacent structures. The anterior clinoid process must not be removed in one piece. Clinoid folds and the frontotemporal fold should be exposed adequately. The falciform ligament must be cut to visualize the optic nerve and ophthalmic artery clearly. Preoperative radiological assessment of clinoid process variations should be done. In computerized tomography scans, pneumatization of the right anterior clinoid process was found in 12%, of the left anterior clinoid process in 7% and bilaterally pneumatization was present in 9%.
Removal of the ACP is one of the most critical procedures to the successful and safe management of ophthalmic segment aneurysms and tumors located in the paraclinoid region and cavernous sinus. Special attention should be paid to the anatomic landmarks indicating the relationship between the anterior clinoid process and adjacent structures. Beside that, pneumatization of the anterior clinoid process should be evaluated preoperatively with computed tomography to avoid complications such as rhinorrhea and pneumocephalus.
研究床突的显微外科和放射解剖结构，以便为外科医生提供更多关于前床突及其在硬膜内和硬膜外床突切除术中与周围血管和神经关系的详细信息，从而使手术操作更安全。
研究7例福尔马林固定标本（14侧）和2例新鲜尸体标本（4侧），以揭示前床突及相关标志在床突硬膜内和硬膜外钻孔技术中的手术解剖结构。此外，对100例鼻窦断层扫描（200侧）进行前床突气化情况的研究。
必须小心钻磨前床突，以免损伤极其重要的相邻结构。前床突不应整块切除。应充分暴露床突皱襞和额颞皱襞。必须切断镰状韧带，以便清晰显示视神经和眼动脉。术前应进行床突变异的放射学评估。在计算机断层扫描中，发现右侧前床突气化的占12%，左侧前床突气化的占7%，双侧气化的占9%。
切除前床突是成功安全治疗眼动脉段动脉瘤及位于床突旁区域和海绵窦肿瘤的关键步骤之一。应特别注意表明前床突与相邻结构关系的解剖标志。除此之外，术前应通过计算机断层扫描评估前床突气化情况，以避免脑脊液鼻漏和气颅等并发症。
