Tag: Caroticoclinoid ring

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Caroticoclinoid Bar: A Systematic Review and Meta-Analysis of Its Prevalence and Potential Implications in Cerebrovascular and Skull Base Surgery

World Neurosurg. (2019) 124:267-276

The presence of a caroticoclinoid bar (CCB) has been implicated in both transcranial and endonasal surgery. Its morphology reflects differences in the microsurgical anatomy of the parasellar area and its manipulation during anterior or middle clinoidectomy can result in internal carotid artery injury. Although adjustment of the surgical technique according to the CCB anatomic variants is required for safe surgical access to the paraclinoid region, a review indicated the lack of a systematic assortment of reported data regarding the prevalence of the CCB. Thus, our objective was to systematically review and document the prevalence of the CCB and its anatomic variations.

METHODS: Three databases were systematically reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement through August 2018 to identify relevant studies.

RESULTS: A total of 27 reports (7521 subjects or specimens, 14,449 sides) were included in the present meta-analysis. The overall pooled prevalence of the CCB was 32.6% (95% confidence interval [CI], 26.6%e38.8%) when measured in the subjects or specimens and 23.6% (95% CI, 19.7%e27.6%) when measured in each side. The overall prevalence of the CCB reported from imaging studies was 23.1% (95% CI, 8.9%e41.4%) for the subjects/specimens and 18.7% (95% CI, 12.6%e25.7%) for each side. The presence of the CCB was slightly more prevalent (P [ 0.050) on the right side.

CONCLUSIONS: Our results showed a considerable prevalence of the CCB, with lower prevalence rates found among imaging studies. Although meticulous preoperative investigation is mandatory, surgeons treating patients with parasellar pathologic entities should always be vigilant regarding the CCB.

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The Recesses of the Sellar Wall of the Sphenoid Sinus and Their Intracranial Relationships

The_Recesses_of_the_Sellar_Wall_of_the_Sphenoid

Neurosurgery 73[ONS Suppl 2]:ons117–ons131, 2013

The sellar wall of the sphenoid sinus and its recesses have been previously studied, but their intracranial relationships to the diaphragma sellae, tuberculum, clinoid segment of the internal carotid artery, chiasmatic sulcus, and middle clinoid process need further definition.

OBJECTIVE: To describe these intra- and extracranial relationships of the recesses in the anterior sellar wall.

METHODS: The middle clinoid was studied in 132 parasellar areas of dry crania. Thirtyeight parasellar areas of formalin-fixed/silicone-colored specimens were dissected. After transsphenoidal endoscopic exposure, the optic, carotid, and sellar prominences; lateral opticocarotid and tuberculum recesses; and caroticosellar and medial opticocarotid points were identified. High-speed drills opened 1-mm perforations at these points to allow study of intracranial relationships.

RESULTS: Two recesses and 2 junction points can be recognized in the sphenoid sinus: lateral opticocarotid and tuberculum recesses and medial opticocarotid and caroticosellar points. The lateral opticocarotid recess corresponds to the optic strut base, and the clinoid segment of the internal carotid artery is located medially. The diaphragma sellae attachment is at the level of the tuberculum recess, which in 50% of cases corresponds to the tuberculum. A middle clinoid in base or height greater than 1.5 mm is present in 21.1% and a caroticoclinoid ring in 3%. The middle clinoid is 1 mm inferior and lateral to the caroticosellar point and 4.7 mm inferior to the medial opticocarotid point.

CONCLUSION: An understanding of the intra- and extracranial relationships of the recesses of the sphenoid sinus will aid in accurately directing transsphenoidal approaches.

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