Rennert Robert C, Brandel Michael G, Steinberg Jeffrey A, Martin Joel R, Gonda David D, Fukushima Takanori, Day John D, Khalessi Alexander A, Levy Michael L
Department of Neurological Surgery, University of California, San Diego, La Jolla, California.
Department of Neurosciences and Pediatrics, University of California, San Diego, San Diego, California.
Oper Neurosurg (Hagerstown). 2021 Feb 16;20(3):E200-E207. doi: 10.1093/ons/opaa374.
Removal of the anterior clinoid process (ACP) can expand anterior skull base surgical corridors. ACP development and anatomical variations are poorly defined in children.
To perform a morphometric analysis of the ACP during pediatric maturation.
Measurements of ACP base thickness (ACP-BT), midpoint thickness (ACP-MT), length (ACP-L), length from optic strut to ACP tip (ACP-OS), pneumatization (ACP-pneumo), and the presence of an ossified carotico-clinoid ligament (OCCL) or interclinoid ligament (OIL) were made from high-resolution computed-tomography scans from 60 patients (ages 0-3, 4-7, 8-11 12-15, 16-18, and >18 yr). Data were analyzed by laterality, sex, and age groups using t-tests and linear regression.
There were no significant differences in ACP parameters by laterality or sex, and no significant growth in ACP-BT or ACP-MT during development. From ages 0-3 yr to adult, mean ACP-L increased 49%, from 7.7 to 11.5 mm. The majority of ACP-L growth occurred in 2 phases between ages 0-3 to 8-11 and ages 16-18 to adult. Conversely, ACP-OS was stable from ages 0-3 to 8-11 but increased by 63% between ages 8-11 to adult. Variations in ACP morphology (OCCL/OIL/ACP-pneumo) were found in 15% (9/60) of scans. OCCL and OIL occurred in patients as young as 3 yrs, whereas ACP-pneumo was not seen in patients younger than 11 yrs.
The ACP demonstrates stable thickness and a complex triphasic elongation and remodeling pattern with development, the understanding of which may facilitate removal in patients <12. Clinically relevant ACP anatomic variations can occur at any age.
切除前床突（ACP）可扩大前颅底手术通道。儿童中ACP的发育及解剖变异情况尚不明确。
对儿童发育过程中的ACP进行形态学分析。
对60例患者（年龄0 - 3岁、4 - 7岁、8 - 11岁、12 - 15岁、16 - 18岁及>18岁）的高分辨率计算机断层扫描进行测量，内容包括ACP基底厚度（ACP - BT）、中点厚度（ACP - MT）、长度（ACP - L）、从视柱到ACP尖端的长度（ACP - OS）、气化情况（ACP - 气房）以及是否存在骨化的颈动脉床突韧带（OCCL）或床突间韧带（OIL）。使用t检验和线性回归按左右侧、性别和年龄组对数据进行分析。
ACP参数在左右侧或性别上无显著差异，发育过程中ACP - BT或ACP - MT无显著增长。从0 - 3岁到成人，平均ACP - L增加了49%，从7.7毫米增至11.5毫米。ACP - L的增长主要发生在0 - 3岁至8 - 11岁以及16 - 18岁至成人这两个阶段。相反，ACP - OS在0 - 3岁至8 - 11岁时稳定，但在8 - 11岁至成人之间增加了63%。在15%（9/60）的扫描中发现了ACP形态的变异（OCCL/OIL/ACP - 气房）。OCCL和OIL在年仅3岁的患者中出现，而ACP - 气房在11岁以下患者中未见。
ACP显示出稳定的厚度以及随着发育呈现复杂的三相伸长和重塑模式，了解这一点可能有助于12岁以下患者的切除手术。临床上相关的ACP解剖变异可在任何年龄出现。
