Endoscopic Transorbital Anterior Clinoidectomy: A Cadaveric Study

Objectives: The objectives of this study are to detail the procedure for performing an endoscopic transorbital anterior clinoidectomy, to critically analyze the technique, evaluate its safety, and examine its potential applications.

Background: Anterior clinoidectomy is a pivotal technique in skull base and vascular neurosurgery. The integration of this procedure into the growing field of endoscopic transorbital approaches may offer a valuable tool for surgeons.

Methods: We conducted this procedure on three cadaver heads, totaling five approaches, at the Madison Microneurosurgery Laboratory, University of Wisconsin. We utilized Storz endoscopes with 0- and 30-degree viewing angles, 4 mm in diameter, and 275 mm in length. The approach used a high-speed drill to access the middle fossa, the anterior fossa, and to remove the sphenoid wing. Subsequent steps included opening the optic canal roof, hollowing the anterior clinoid, drilling the optic strut, and removing the anterior clinoid process.

Results: In all five approaches, the anterior clinoid was successfully removed without damaging the optic nerve or carotid artery. Although the optic canal roof opening was executed in a confined space, the drilling of the optic strut was performed under direct visualization, ensuring the safety of the optic nerve and the carotid artery.

Conclusion: Anterior clinoidectomy is an essential technique in skull base and vascular neurosurgery, useful for tumor resections, decompression of the optic nerve, and enhancing access to surgical targets in skull base surgery. Our findings suggest that anterior clinoidectomy can be safely executed via an endoscopic transorbital approach.

Publication History

Article published online:
07 February 2025