Kimura Toshikazu, Morita Akio
Department of Neurosurgery, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan.
Department of Neurosurgery, Nippon Medical University, Sendagi Bukyo-ku, Tokyo, Japan.
World Neurosurg. 2019 Jun;126:e447-e452. doi: 10.1016/j.wneu.2019.02.071. Epub 2019 Feb 28.
Anterior clinoidectomy is considered difficult because important structures are adjacent to but hidden behind the anterior clinoid process (ACP). We sought to make anterior clinoidectomy a simpler procedure.
A modification of anterior clinoidectomy is presented. To obtain a radiologic basis, original images from 357 consecutive sets of computed tomography angiography data were assessed.
Anterior clinoidectomy was performed in 77 consecutive patients, as follows. By making a small window in the lateral wall of the ACP and curetting out the content inside, the lateral wall of the optic canal was easily exposed and functioned as a landmark for removal of the remaining bone. In addition, by removing the posterior edge and thinning the lateral part, the ACP was fractured and removed. The optic canal was opened if needed. No complications due to anterior clinoidectomy were observed. Among the 689 sides evaluated, 641 sides showed cancellous bone and 29 showed well-developed pneumatization inside the ACP. In each ACP examined, we observed the presence of compact bone facing the optic nerve, which constitutes the lateral wall of the optic canal. On 180 sides, part of the compact bone between the clinoid process and the internal carotid artery was absent; in other cases, thin compact bone was present.
Visualizing the optic canal in the early stage of the procedure allows anterior clinoidectomy to be performed safely.
前床突切除术被认为具有难度，因为重要结构紧邻前床突（ACP）但隐藏于其后。我们试图使前床突切除术成为一种更简单的手术。
介绍了一种前床突切除术的改良方法。为获得影像学依据，对连续357组计算机断层血管造影数据的原始图像进行了评估。
连续77例患者接受了前床突切除术，具体如下。通过在ACP侧壁开一个小窗口并刮除内部内容物，视神经管侧壁很容易暴露，并作为切除剩余骨质的标志。此外，通过去除后缘并使外侧部分变薄，ACP发生骨折并被切除。如有需要，可打开视神经管。未观察到因前床突切除术引起的并发症。在评估的689侧中，641侧显示为松质骨，29侧显示ACP内部有发达的气化。在每侧检查的ACP中，我们观察到面向视神经的致密骨的存在，其构成视神经管的侧壁。在180侧，床突与颈内动脉之间的部分致密骨缺失；在其他情况下，存在薄的致密骨。
在手术早期对视神经管进行可视化处理可使前床突切除术安全进行。
