gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

Anterior clinoid process (ACP) resection for parasellar lesions: indication and technique

Resektion des vorderen Clinoidfortsatzes für paraselläre Läsionen: Indikation und Technik

Meeting Abstract

  • corresponding author L. Benes - Department of Neurosurgery, Philipps-University, Medical Center, Marburg
  • C. Kappus - Department of Neurosurgery, Philipps-University, Medical Center, Marburg
  • D. M. Schulte - Department of Neurosurgery, Philipps-University, Medical Center, Marburg
  • J. Rohlfs - Department of Neurosurgery, Philipps-University, Medical Center, Marburg
  • S. Heinze - Department of Neurosurgery, Philipps-University, Medical Center, Marburg
  • H. Bertalanffy - Department of Neurosurgery, Philipps-University, Medical Center, Marburg

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc09.05.-06.01

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2005/05dgnc0016.shtml

Veröffentlicht: 4. Mai 2005

© 2005 Benes et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

The parasellar region is the center of various pathologies. In a retrospective analysis we describe our experience, indication and technique of anterior clinoidectomy in a large patient population with parasellar pathologies.

Methods

Over a period of 7 years, anterior clinoidectomy was performed in 67 patients via a pterional craniotomy. The pathologies were subdivided into 4 groups: a) ICA-aneurysms n= 26 (ophthalmic, infraclinoid, supraclinoid), b) meningiomas n=28 (sphenoid wing, parasellar/cavernous, frontal, optical sheet/intraorbital), c) tumours of the orbit n=5 (optic glioma, optic neuritis) and d) miscellaneous n=7 (craniopharyngioma, pituitary adenoma, metastatic carcinoma, osteoma of anterior clinoid, fibrous dysplasia) and retrospectively analyzed. Successful clipping or tumour resection was either documented in a postoperative angiography or a postoperative MRI in all cases. The surgical technique is described in a video-presentation.

Results

All patients underwent anterior clinoidectomy with successful exposure and mobilization of the ICA and the optic nerve. There was no major complication directly related to the ACP removal in terms of optic nerve trauma or ICA or aneurysm perforation. In 16.4% (n=11) patients (with lesions involving either the cavernous sinus or the orbit), mostly temporary deficits of the CN III, IV and VI occurred. There were no visual deficits associated with anterior clinoidectomy. In the vascular group, all aneurysms could be clipped. Tumour resection was complete in 20 (71,4%) cases, partial resection with optic nerve decompression could be achieved in 4 (14,3%) cases, biopsy with optic nerve decompression in 4 (14,3%) cases. Tumours of the orbit were partially resected or biopsy was taken, both with optic nerve decompression.

Conclusions

The removal of the anterior clinoid process (APC) is favourable and safe, facilitating complete resection of tumours and sufficient clipping of complex ICA/ophthalmic aneurysms by providing a considerable operative exposure with minimal brain retraction and additional space for displacing the ICA and the optic nerve in the parasellar region.