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.
