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DOI: 10.1055/s-0032-1313982
Intraoperative CT Guidance to Confirm Decompression Following an Endonasal Approach for the Treatment of Cervicomedullary Compression
Introduction: The middle clinoid is an osseous prominence that arises from the body of the sphenoid bone at the anterolateral margin of the sella turcica. The presence of a middle clinoid is not constant. In an unknown number of patients, a calcified ligament may exist between the middle and anterior clinoids creating a foramen within which the carotid artery lies. This is known as the caroticoclinoidal foramen. Identifying the existence of this structure is paramount to safe removal of the middle clinoid in endonasal skull base approaches.
Methods: The thin-slice (<2.5 mm) CT scans of 100 patients who underwent endonasal skull base procedures were reviewed. All patients with sellar pathology that enlarged or eroded the sella were excluded. All instances of a caroticoclinoidal foramen where documented.
Results: At least one caroticoclinoidal foramen was identified in 19% of patients. In 10% of patients, bilateral foramina were identified. In patients with unilateral foramina, a right foramen was present in 2%, and a left foramen was present in 7%.
Conclusions: Recognition of the caroticoclinoidal foramen on preoperative radiographs is important for surgical planning and middle clinoid removal in endonasal skull base surgery. At least one caroticoclinoidal foramen was recognized in 19% of patients.