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Intradural Clinoidectomy

Last Updated: March 13, 2020

Intradural Clinoidectomy for a Large Paraclinoid Aneurysm

General Considerations

Anterior clinoidectomy is an important tool for neurovascular and skull base surgery. This technique is cardinal in expanding access to the sella, proximal carotid artery, and central skull base. The goal of anterior clinoidectomy is to the reveal the more proximal ophthalmic and clinoidal segments of the internal carotid artery (ICA) while unroofing the optic canal and skeletonizing the proximal optic nerve. This maneuver expands the optico-carotid and carotid-oculomotor access windows and therefore the operative corridor to the interpeduncular cisterns. Both the carotid artery and optic nerve are partially untethered and can be more safely and gently mobilized.

Controversy surrounds the value of clinoidectomy for “appropriately selected” cases. Moreover, there is no consensus on the indications and benefits of extradural versus intradural clinoidectom...