Quantitative Anterior and Posterior Clinoidectomy Analysis and Mobilization of the Oculomotor Nerve during Surgical Exposure of the Basilar Apex Using Frameless Stereotaxis

Aclan Dogan, Justin Cetas, Gregory Anderson, Andrew (Andy) Rekito, Johnny B. Delashaw

Research output: Contribution to journalArticle

Abstract

Background Anterior and posterior clinoidectomies have been proposed to augment exposure of the basilar apex. A sequential quantitative benefit analysis offered by these maneuvers has not been reported. Methods Fourteen datasets from eight cadaveric specimens were analyzed. A modified orbitozygomatic frontotemporal craniotomy was performed. The extent of proximal control of the basilar artery was determined through the exposed opticocarotid and carotidoculomotor triangles before and after clinoidectomies and mobilization of the third nerve at the porous oculomotarius. Results Removal of the anterior and posterior clinoids significantly improved proximal basilar artery access (p < 0.012) and increased the opticocarotid triangle and carotidoculomotor triangle areas (p < 0.017). Surgical freedom increased inferosuperiorally in the opticocarotid triangle following anterior clinoidectomy (p < 0.047) and in carotidoculomotor triangle following posterior clinoidectomy (p < 0.047). Mobilization of the third nerve increased surgical freedom in the mediolateral projection of the carotidoculomotor triangle (p < 0.047). Conclusion Anterior and posterior clinoidectomies significantly improved the area of exposure of the opticocarotid triangle, carotidoculomotor triangle, and the exposed length of the basilar artery available for proximal control. This improvement is extremely important for large or giant aneurysms of the upper basilar artery or aneurysms hidden by the posterior clinoid.

Original languageEnglish (US)
JournalJournal of Neurological Surgery, Part B: Skull Base
DOIs
StateAccepted/In press - Nov 20 2016

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Oculomotor Nerve
Basilar Artery
Craniotomy
Intracranial Aneurysm
Aneurysm

Keywords

  • anterior clinoidectomy
  • basilar apex
  • carotidoculomotor triangle
  • opticocarotid triangle
  • posterior clinoidectomy
  • third nerve mobilization

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

@article{5823baa08d254541ae971d9fec660473,
title = "Quantitative Anterior and Posterior Clinoidectomy Analysis and Mobilization of the Oculomotor Nerve during Surgical Exposure of the Basilar Apex Using Frameless Stereotaxis",
abstract = "Background Anterior and posterior clinoidectomies have been proposed to augment exposure of the basilar apex. A sequential quantitative benefit analysis offered by these maneuvers has not been reported. Methods Fourteen datasets from eight cadaveric specimens were analyzed. A modified orbitozygomatic frontotemporal craniotomy was performed. The extent of proximal control of the basilar artery was determined through the exposed opticocarotid and carotidoculomotor triangles before and after clinoidectomies and mobilization of the third nerve at the porous oculomotarius. Results Removal of the anterior and posterior clinoids significantly improved proximal basilar artery access (p < 0.012) and increased the opticocarotid triangle and carotidoculomotor triangle areas (p < 0.017). Surgical freedom increased inferosuperiorally in the opticocarotid triangle following anterior clinoidectomy (p < 0.047) and in carotidoculomotor triangle following posterior clinoidectomy (p < 0.047). Mobilization of the third nerve increased surgical freedom in the mediolateral projection of the carotidoculomotor triangle (p < 0.047). Conclusion Anterior and posterior clinoidectomies significantly improved the area of exposure of the opticocarotid triangle, carotidoculomotor triangle, and the exposed length of the basilar artery available for proximal control. This improvement is extremely important for large or giant aneurysms of the upper basilar artery or aneurysms hidden by the posterior clinoid.",
keywords = "anterior clinoidectomy, basilar apex, carotidoculomotor triangle, opticocarotid triangle, posterior clinoidectomy, third nerve mobilization",
author = "Aclan Dogan and Justin Cetas and Gregory Anderson and Rekito, {Andrew (Andy)} and Delashaw, {Johnny B.}",
year = "2016",
month = "11",
day = "20",
doi = "10.1055/s-0036-1597813",
language = "English (US)",
journal = "Journal of Neurological Surgery, Part B: Skull Base",
issn = "2193-6331",
publisher = "Thieme Medical Publishers",

}

TY - JOUR

T1 - Quantitative Anterior and Posterior Clinoidectomy Analysis and Mobilization of the Oculomotor Nerve during Surgical Exposure of the Basilar Apex Using Frameless Stereotaxis

AU - Dogan, Aclan

AU - Cetas, Justin

AU - Anderson, Gregory

AU - Rekito, Andrew (Andy)

AU - Delashaw, Johnny B.

PY - 2016/11/20

Y1 - 2016/11/20

N2 - Background Anterior and posterior clinoidectomies have been proposed to augment exposure of the basilar apex. A sequential quantitative benefit analysis offered by these maneuvers has not been reported. Methods Fourteen datasets from eight cadaveric specimens were analyzed. A modified orbitozygomatic frontotemporal craniotomy was performed. The extent of proximal control of the basilar artery was determined through the exposed opticocarotid and carotidoculomotor triangles before and after clinoidectomies and mobilization of the third nerve at the porous oculomotarius. Results Removal of the anterior and posterior clinoids significantly improved proximal basilar artery access (p < 0.012) and increased the opticocarotid triangle and carotidoculomotor triangle areas (p < 0.017). Surgical freedom increased inferosuperiorally in the opticocarotid triangle following anterior clinoidectomy (p < 0.047) and in carotidoculomotor triangle following posterior clinoidectomy (p < 0.047). Mobilization of the third nerve increased surgical freedom in the mediolateral projection of the carotidoculomotor triangle (p < 0.047). Conclusion Anterior and posterior clinoidectomies significantly improved the area of exposure of the opticocarotid triangle, carotidoculomotor triangle, and the exposed length of the basilar artery available for proximal control. This improvement is extremely important for large or giant aneurysms of the upper basilar artery or aneurysms hidden by the posterior clinoid.

AB - Background Anterior and posterior clinoidectomies have been proposed to augment exposure of the basilar apex. A sequential quantitative benefit analysis offered by these maneuvers has not been reported. Methods Fourteen datasets from eight cadaveric specimens were analyzed. A modified orbitozygomatic frontotemporal craniotomy was performed. The extent of proximal control of the basilar artery was determined through the exposed opticocarotid and carotidoculomotor triangles before and after clinoidectomies and mobilization of the third nerve at the porous oculomotarius. Results Removal of the anterior and posterior clinoids significantly improved proximal basilar artery access (p < 0.012) and increased the opticocarotid triangle and carotidoculomotor triangle areas (p < 0.017). Surgical freedom increased inferosuperiorally in the opticocarotid triangle following anterior clinoidectomy (p < 0.047) and in carotidoculomotor triangle following posterior clinoidectomy (p < 0.047). Mobilization of the third nerve increased surgical freedom in the mediolateral projection of the carotidoculomotor triangle (p < 0.047). Conclusion Anterior and posterior clinoidectomies significantly improved the area of exposure of the opticocarotid triangle, carotidoculomotor triangle, and the exposed length of the basilar artery available for proximal control. This improvement is extremely important for large or giant aneurysms of the upper basilar artery or aneurysms hidden by the posterior clinoid.

KW - anterior clinoidectomy

KW - basilar apex

KW - carotidoculomotor triangle

KW - opticocarotid triangle

KW - posterior clinoidectomy

KW - third nerve mobilization

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U2 - 10.1055/s-0036-1597813

DO - 10.1055/s-0036-1597813

M3 - Article

JO - Journal of Neurological Surgery, Part B: Skull Base

JF - Journal of Neurological Surgery, Part B: Skull Base

SN - 2193-6331

ER -