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open access

Vol 72, No 2 (2013)
Original article
Submitted: 2013-06-03
Accepted: 2013-06-03
Published online: 2013-05-01
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The pneumatisation of anterior clinoid process is not associated with any predictors that might be recognised preoperatively

T. Szmuda, P. Sloniewski, A. Baczalska, M. Cabala, B. Czapski, A. Gorczynski, N. Kreja, M. Kindrachuk
DOI: 10.5603/FM.2013.0017
·
Folia Morphol 2013;72(2):100-106.

open access

Vol 72, No 2 (2013)
ORIGINAL ARTICLES
Submitted: 2013-06-03
Accepted: 2013-06-03
Published online: 2013-05-01

Abstract

The anterior clinoid process (ACP) is usually removed during surgeries of proximalinternal carotid artery (ICA) aneurysms. However, some ACPs presentwith air cells originating from the sphenoid or/and ethmoid sinus. In surgeriescontaining a clinoidectomy of a pneumatised process, up to 40% of patients experience cerebrospinal fluid (CSF) rhinorrhoea. The aim of this study wasto explore the potential predictors of pneumatisation of the ACP, as well asto compare the occurrence of CSF rhinorrhoea between total and partialanterior clinoidectomies. This study comprised 2 different groups, with 2 differentanalyses. Firstly, the pneumatisation of the ACP was evaluated in 496 ACPs and was based on 248 computer tomography exams (CT). The c2 testand ROC curve comparisons were utilised in conjunction, to explore possiblepredictors of air cell accumulation in the ACP. The overall pneumatisation ratewas 9.7%, unilateral and bilateral aerial ACP was found in 4.4% and 2.6% of all patients respectively, while at least one pneumatised ACP was found in 14.1% of examined patients. The route of pneumatisation was establishedin 87.5% of cases. The side of the ACP, gender, and patient age were notsignificantly associated with both pneumatisation of ACP or route of pneumatisation.Secondly, a clinical group of 23 patients after operative securingof an ICA aneurysm were retrospectively assessed with regards to the extentof anterior clinoidectomy and the occurrence of CSF rhinorrhoea. A total of23 ACPs were removed, 17 ACPs were totally resected, and 6 underwent partialresection. CSF rhinorrhoea was not noted in any patients, thus the comparison between clinical groups was not valid. Moreover, we described a novelmethod of partial removal of the lateral aspect of ACP, which was applied in6 patients treated for an ICA — ophthalmic artery junction aneurysm.

Abstract

The anterior clinoid process (ACP) is usually removed during surgeries of proximalinternal carotid artery (ICA) aneurysms. However, some ACPs presentwith air cells originating from the sphenoid or/and ethmoid sinus. In surgeriescontaining a clinoidectomy of a pneumatised process, up to 40% of patients experience cerebrospinal fluid (CSF) rhinorrhoea. The aim of this study wasto explore the potential predictors of pneumatisation of the ACP, as well asto compare the occurrence of CSF rhinorrhoea between total and partialanterior clinoidectomies. This study comprised 2 different groups, with 2 differentanalyses. Firstly, the pneumatisation of the ACP was evaluated in 496 ACPs and was based on 248 computer tomography exams (CT). The c2 testand ROC curve comparisons were utilised in conjunction, to explore possiblepredictors of air cell accumulation in the ACP. The overall pneumatisation ratewas 9.7%, unilateral and bilateral aerial ACP was found in 4.4% and 2.6% of all patients respectively, while at least one pneumatised ACP was found in 14.1% of examined patients. The route of pneumatisation was establishedin 87.5% of cases. The side of the ACP, gender, and patient age were notsignificantly associated with both pneumatisation of ACP or route of pneumatisation.Secondly, a clinical group of 23 patients after operative securingof an ICA aneurysm were retrospectively assessed with regards to the extentof anterior clinoidectomy and the occurrence of CSF rhinorrhoea. A total of23 ACPs were removed, 17 ACPs were totally resected, and 6 underwent partialresection. CSF rhinorrhoea was not noted in any patients, thus the comparison between clinical groups was not valid. Moreover, we described a novelmethod of partial removal of the lateral aspect of ACP, which was applied in6 patients treated for an ICA — ophthalmic artery junction aneurysm.

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Keywords

skull, middle cranial fossa, anterior clinoid process, internal carotid artery, sphenoid sinus, ethmoid sinus, anterior clinoidectomy, brain aneurysm, neurosurgical technique

About this article
Title

The pneumatisation of anterior clinoid process is not associated with any predictors that might be recognised preoperatively

Journal

Folia Morphologica

Issue

Vol 72, No 2 (2013)

Article type

Original article

Pages

100-106

Published online

2013-05-01

Page views

2559

Article views/downloads

11792

DOI

10.5603/FM.2013.0017

Bibliographic record

Folia Morphol 2013;72(2):100-106.

Keywords

skull
middle cranial fossa
anterior clinoid process
internal carotid artery
sphenoid sinus
ethmoid sinus
anterior clinoidectomy
brain aneurysm
neurosurgical technique

Authors

T. Szmuda
P. Sloniewski
A. Baczalska
M. Cabala
B. Czapski
A. Gorczynski
N. Kreja
M. Kindrachuk

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