Anterior clinoidectomy for proximal vascular control

Abstract

Clipping of paraclinoid aneurysms remains a surgical challenge due to limited space for dissection and maneuver, and most importantly the lack of space to have proximal vascular control to the aneurysm. Most often the proximal internal carotid aneurysm is obscured by the anterior clinoid process or involved in the cavernous sinus. This is an anatomical study to investigate the space gained by anterior clinoidectomy to allow application of aneurysm clips for proximal vascular control during clipping of aneurysm. Four clinoidectomy were performed in cadavers and the gain in exposure to the internal carotid artery was measured. The aim of the study is to investigate the extra exposure allowed for application of temporary aneurysm clip, and decide whether anterior clinoidectomy can replace the need of neck incision for proximal control during clipping of aneurysm.