Silva Danilo, Attia Moshe, Kandasamy Jothy, Alimi Marjan, Anand Vijay K, Schwartz Theodore H
Department of Neurosurgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York.
Surg Neurol Int. 2012;3:64. doi: 10.4103/2152-7806.97008. Epub 2012 Jun 9.
Posterior clinoidectomy is a useful procedure for maximizing exposure to the interpeduncular cistern via transcranial approaches for basilar tip aneurysms and select intracranial tumors. The value of posterior clinoidectomy during endonasal endoscopic transclival surgery is not well described.
We performed endoscopic endonasal transsphenoidal extradural bilateral posterior clinoidectomy and dorsum sella removal on five silicon-injected cadaveric heads. The dorsum sella was split in the midline and removed from medial to lateral until the posterior clinoids were encountered. The posterior clinoid was dissected from the medial wall of the cavernous sinus and mobilized medially in order to detach it from the ligaments and carefully fractured it from the bony attachment to the petrous apex and carotid canal. Following this, the clival and dorsum sella dura was opened to expose the interpeduncular cistern and its contents.
The technical feasibility of endoscopic endonasal extradural posterior clinoidectomy was reproduced in all five cadaveric specimens. This technique was performed without damaging the vital structures, including preservation of the pituitary gland. After performing bilateral posterior clinoidectomy, the retrosellar dura was opened, allowing good visualization of the contents of the prepontine and interpeduncular cistern.
We describe the technique of endoscopic endonasal extradural posterior clinoidectomy. We believe this approach is best suited for retrosellar pathology located in the interpeduncular cistern and is a useful adjunct to the transclival approach to increase the field of view and maximize the extent of resection.
后床突切除术是一种通过经颅入路最大限度暴露脚间池以治疗基底动脉尖动脉瘤和某些颅内肿瘤的有用手术。鼻内镜经斜坡手术中后床突切除术的价值尚未得到充分描述。
我们对5个注射了硅胶的尸头进行了鼻内镜经蝶窦硬膜外双侧后床突切除术及鞍背切除术。将鞍背在中线处劈开，从内侧向外侧切除，直至遇到后床突。将后床突从海绵窦内侧壁分离并向内侧移动，以使其与韧带分离，并小心地将其从与岩尖和颈动脉管的骨性附着处折断。在此之后，打开斜坡和鞍背硬脑膜以暴露脚间池及其内容物。
在所有5个尸检标本中均重现了鼻内镜经鼻硬膜外后床突切除术的技术可行性。该技术在不损伤重要结构（包括保留垂体）的情况下进行。双侧后床突切除术后，打开鞍后硬脑膜，可清晰观察脑桥前池和脚间池的内容物。
我们描述了鼻内镜经鼻硬膜外后床突切除术的技术。我们认为这种方法最适合位于脚间池的鞍后病变，是经斜坡入路的有用辅助手段，可增加视野并最大限度扩大切除范围。
