Surgical anatomy of the periclinoid region and extradural preparation of the surgical corridors to the sellar and parasellar areas
EANS Academy. Bernardo A. 09/25/19; 275308; EP04080
Prof. Dr. Antonio Bernardo
Prof. Dr. Antonio Bernardo

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Background: Surgical approaches to the sellar and parasellar regions are challenging due to the densely packed nature of the traversing neurovasculature. Extensive extra-dural preparation and dissection within the periclinoid regions significantly eases and facilitates later surgical exposure of deep-seated skull base targets. We describe the techniques and advantages associated with each of these surgical maneuvers in order to provide a framework for surgical decision making that enables an optimal surgical corridor to a given skull base lesion.
Methods: Ten human cadaveric specimens (20 sides) underwent frontotemporal (pterional), fronto-orbital, and fronto-orbitozygomatic craniotomies. The region of the exposure provided by each of these osteotomies was evaluated and the following surgical maneuvers were performed and described in detail: cutting of the meningo-orbital band, drilling of the anterior clinoid process, skeletonization of the superior orbital fissure, exposure and opening of the annulus of Zinn, partial medial and complete unroofing of the optic canal, and cutting of the distal dural ring. The relative surgical advantages of each maneuver were assessed.
Results: Detachment of the meningo-orbital band enabled retraction of the temporal lobe from the superior orbital fissure and exposure of the anterior portion of cavernous sinus. Anterior clinoidectomy facilitated access to the optic nerve, oculomotor nerve, clinoid segment of the internal carotid artery, ophthalmic artery, optic strut, roof of the cavernous sinus, and the supraclinoid intradural region. Skeletonization of the superior orbital fissure allowed for unlocking of the intra- and extra-annular structures, facilitating the transcavernous corridor. Cutting of the distal dural rings allowed for mobilization of the paraclinoid internal carotid artery, enhancing exposure of the anterior and lateral perisellar areas.
Conclusion: Sufficient extradural preparation of the periclinoid region significantly eases and facilitates the later use of intradural surgical corridors to deep-seated skull base targets.
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