{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T01:51:21Z","timestamp":1768873881443,"version":"3.49.0"},"reference-count":21,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,10,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Mastery of the posterior clinoidectomy technique is of utmost importance for neurosurgeons who specialize in endoscopic endonasal approaches, because the posterior clinoid process (PCP) is commonly involved in chondroid tumor resection. Three main techniques for posterior clinoidectomy have been developed: intradural, extradural, and transcavernous interdural. The authors introduce here a novel technical variant in which the transcavernous approach is extended to the dorsal clinoidal space after transection of the caroticoclinoid ligament, and they elaborate on its clinical application on the basis of anatomical dissections and radiological studies.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The authors reviewed CT angiography images and 3D reconstruction of the PCP in 50 adults to analyze the height and presence of ossified ligament attachments. In addition, endoscopic endonasal posterior clinoidectomy was performed in 20 lightly embalmed postmortem human heads. Three techniques, including extradural, transcavernous, and extended transcavernous posterior clinoidectomy, were performed sequentially, and anatomical landmarks and areas exposed with each technique were investigated and compared.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Using radiological studies, the authors categorized the PCPs as 1 of 2 types: 1) normal, defined as less than or equal to 8 mm high with no ossified ligament attachments; or 2) complex, defined as greater than 8 mm high with or without an ossified ligament attachment. Compared with extradural (exposed PCP height 4.7 \u00b1 0.5 mm) and transcavernous (exposed PCP height 7.3 \u00b1 0.8 mm) posterior clinoidectomies, the extended transcavernous posterior clinoidectomy provided the maximally exposed PCP height (9.6 \u00b1 0.4 mm; p &lt; 0.0001).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>This report details the extended transcavernous posterior clinoidectomy as a novel technical variant for achieving maximal exposure of the PCP in endoscopic endonasal surgery. In addition, the positive results establish the importance of preoperative skull base imaging for surgical planning.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.6.jns24606","type":"journal-article","created":{"date-parts":[[2024,10,12]],"date-time":"2024-10-12T01:29:02Z","timestamp":1728696542000},"page":"1-11","source":"Crossref","is-referenced-by-count":2,"title":["Extended transcavernous posterior clinoidectomy in endoscopic endonasal surgery"],"prefix":"10.3171","author":[{"given":"Yuanzhi","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Stanford Hospital, Stanford, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine K.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford Hospital, Stanford, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Rychen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford Hospital, Stanford, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad Reza","family":"Arifianto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford Hospital, Stanford, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maximiliano Alberto","family":"Nunez","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford Hospital, Stanford, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron A.","family":"Cohen-Gadol","sequence":"additional","affiliation":[{"name":"The Neurosurgical Atlas, Carmel, Indiana; and"},{"name":"Department of Neurological Surgery, Indiana University, Indianapolis, Indiana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan C.","family":"Fernandez-Miranda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford Hospital, Stanford, California;"},{"name":"The Neurosurgical Atlas, Carmel, Indiana; and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"2 Suppl Operative","key":"b1","series-title":"Neurosurgery","first-page":"ons155","article-title":"Focal transnasal approach to the upper, middle, and lower clivus","volume":"73","author":"Funaki T","year":"2013","unstructured":"Funaki T, Matsushima T, Peris-Celda M, Valentine RJ, Joo W, Rhoton AL Jr. Focal transnasal approach to the upper, middle, and lower clivus. Neurosurgery. 2013;73(2 Suppl Operative):ons155\u2013ons191."},{"issue":"4","key":"b2","series-title":"J Neurol Surg B Skull Base","first-page":"420","article-title":"Endoscopic endonasal approach to the ventral petroclival fissure: anatomical findings and surgical techniques","volume":"85","author":"Xu Y","year":"2023","unstructured":"Xu Y, Mohyeldin A, Lee CK,  Endoscopic endonasal approach to the ventral petroclival fissure: anatomical findings and surgical techniques. J Neurol Surg B Skull Base. 2023;85(4):420\u2013430."},{"issue":"1","key":"b3","series-title":"Neurosurg Focus","first-page":"E4","article-title":"Expanded endonasal approach: the rostrocaudal axis. Part II. Posterior clinoids to the foramen magnum.","volume":"19","author":"Kassam A","year":"2005","unstructured":"Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL. Expanded endonasal approach: the rostrocaudal axis. Part II. Posterior clinoids to the foramen magnum. . Neurosurg Focus. 2005;19(1):E4."},{"issue":"3 Suppl 1","key":"b4","series-title":"Neurosurgery","first-page":"57","article-title":"Endoscopic endonasal pituitary transposition for a transdorsum sellae approach to the interpeduncular cistern","volume":"62","author":"Kassam AB","year":"2008","unstructured":"Kassam AB, Prevedello DM, Thomas A,  Endoscopic endonasal pituitary transposition for a transdorsum sellae approach to the interpeduncular cistern. Neurosurgery. 2008;62(3 Suppl 1):57\u201374."},{"key":"b5","series-title":"Surg Neurol Int","first-page":"64","article-title":"Endoscopic endonasal posterior clinoidectomy","volume":"3","author":"Silva D","year":"2012","unstructured":"Silva D, Attia M, Kandasamy J, Alimi M, Anand VK, Schwartz TH. Endoscopic endonasal posterior clinoidectomy. Surg Neurol Int. 2012;3:64."},{"issue":"1","key":"b6","series-title":"J Neurosurg","first-page":"135","article-title":"Surgical implementation and efficacy of endoscopic endonasal extradural posterior clinoidectomy","volume":"133","author":"Ohata H","year":"2019","unstructured":"Ohata H, Goto T, Nagm A. Surgical implementation and efficacy of endoscopic endonasal extradural posterior clinoidectomy. J Neurosurg. 2019;133(1):135\u2013143."},{"issue":"6","key":"b7","series-title":"Oper Neurosurg (Hagerstown)","first-page":"625","article-title":"Intradural pituitary hemitransposition: technical note and case series illustration","volume":"26","author":"Almeida JP","year":"2024","unstructured":"Almeida JP, Finger G, Weber MD. Intradural pituitary hemitransposition: technical note and case series illustration. Oper Neurosurg (Hagerstown). 2024;26(6):625\u2013634."},{"issue":"1","key":"b8","series-title":"J Neurosurg","first-page":"91","article-title":"Endoscopic endonasal transcavernous posterior clinoidectomy with interdural pituitary transposition","volume":"121","author":"Fernandez-Miranda JC","year":"2014","unstructured":"Fernandez-Miranda JC, Gardner PA, Rastelli MM Jr,  Endoscopic endonasal transcavernous posterior clinoidectomy with interdural pituitary transposition. J Neurosurg. 2014;121(1):91\u201399."},{"issue":"3","key":"b9","series-title":"Neuroradiol J","first-page":"299","article-title":"Sella turcica bridging and ossified carotico-clinoid ligament: correlation with sex and age","volume":"31","author":"Gibelli D","year":"2018","unstructured":"Gibelli D, Cellina M, Gibelli S. Sella turcica bridging and ossified carotico-clinoid ligament: correlation with sex and age. Neuroradiol J. 2018;31(3):299\u2013304."},{"issue":"5","key":"b10","series-title":"J Neurol Surg B Skull Base","first-page":"534","article-title":"Navigating a carotico-clinoid foramen and an interclinoidal bridge in the endonasal endoscopic approach: an anatomical and technical note","volume":"82","author":"Zhao X","year":"2021","unstructured":"Zhao X, Labib MA, Avci E,  Navigating a carotico-clinoid foramen and an interclinoidal bridge in the endonasal endoscopic approach: an anatomical and technical note. J Neurol Surg B Skull Base. 2021;82(5):534\u2013539."},{"issue":"5","key":"b11","series-title":"J Neurosurg","first-page":"1418","article-title":"Microsurgical anatomy of the dorsal clinoidal space: implications for endoscopic endonasal parasellar surgery","volume":"137","author":"Xu Y","year":"2022","unstructured":"Xu Y, Nunez MA, Mohyeldin A. Microsurgical anatomy of the dorsal clinoidal space: implications for endoscopic endonasal parasellar surgery. J Neurosurg. 2022;137(5):1418\u20131430."},{"issue":"6","key":"b12","series-title":"J Neurosurg","first-page":"1766","article-title":"Pursuing perfect 2D and 3D photography in neuroanatomy: a new paradigm for staying up to date with digital technology","volume":"138","author":"Xu Y","year":"2022","unstructured":"Xu Y, Vigo V, Klein J,  Pursuing perfect 2D and 3D photography in neuroanatomy: a new paradigm for staying up to date with digital technology. J Neurosurg. 2022;138(6):1766\u20131772."},{"issue":"9","key":"b13","series-title":"Magn Reson Imaging","first-page":"1323","article-title":"3D Slicer as an image computing platform for the Quantitative Imaging Network","volume":"30","author":"Fedorov A","year":"2012","unstructured":"Fedorov A, Beichel R, Kalpathy-Cramer J. 3D Slicer as an image computing platform for the Quantitative Imaging Network. Magn Reson Imaging. 2012;30(9):1323\u20131341."},{"issue":"2","key":"b14","series-title":"Oper Neurosurg (Hagerstown)","first-page":"115","article-title":"Intracranial breakthrough through cavernous sinus compartments: anatomic study and implications for pituitary adenoma surgery","volume":"23","author":"Xu Y","year":"2022","unstructured":"Xu Y, Mohyeldin A, Asmaro KP. Intracranial breakthrough through cavernous sinus compartments: anatomic study and implications for pituitary adenoma surgery. Oper Neurosurg (Hagerstown). 2022;23(2):115\u2013124."},{"issue":"6","key":"b15","series-title":"Oper Neurosurg (Hagerstown)","first-page":"619","article-title":"The pterygosphenoidal triangle: surgical anatomy and case series in endoscopic endonasal skull base surgery","volume":"24","author":"Xu Y","year":"2023","unstructured":"Xu Y, Asmaro K, Mohyeldin A,  The pterygosphenoidal triangle: surgical anatomy and case series in endoscopic endonasal skull base surgery. Oper Neurosurg (Hagerstown). 2023;24(6):619\u2013629."},{"issue":"6","key":"b16","series-title":"J Clin Neurosci","first-page":"746","article-title":"Surgical anatomy of the dural walls of the cavernous sinus","volume":"17","author":"Campero A","year":"2010","unstructured":"Campero A, Campero AA, Martins C, Yasuda A, Rhoton AL Jr. Surgical anatomy of the dural walls of the cavernous sinus. J Clin Neurosci. 2010;17(6):746\u2013750."},{"key":"b17","series-title":"Front Oncol","first-page":"724972","article-title":"Endoscopic endonasal surgical strategy for skull base chordomas based on tumor growth directions: surgical outcomes of 167 patients during 3 years","volume":"11","author":"Bai J","year":"2021","unstructured":"Bai J, Li M, Xiong Y,  Endoscopic endonasal surgical strategy for skull base chordomas based on tumor growth directions: surgical outcomes of 167 patients during 3 years. Front Oncol. 2021;11:724972."},{"issue":"2","key":"b18","series-title":"J Neurooncol","first-page":"319","article-title":"Endoscopic transnasal skull base surgery: pushing the boundaries","volume":"130","author":"Zwagerman NT","year":"2016","unstructured":"Zwagerman NT, Zenonos G, Lieber S,  Endoscopic transnasal skull base surgery: pushing the boundaries. J Neurooncol. 2016;130(2):319\u2013330."},{"issue":"4","key":"b19","series-title":"J Neurosurg","first-page":"1304","article-title":"Endoscopic endonasal transoculomotor triangle approach for adenomas invading the parapeduncular space: surgical anatomy, technical nuances, and case series","volume":"130","author":"Ferrareze Nunes C","year":"2018","unstructured":"Ferrareze Nunes C, Lieber S, Truong HQ. Endoscopic endonasal transoculomotor triangle approach for adenomas invading the parapeduncular space: surgical anatomy, technical nuances, and case series. J Neurosurg. 2018;130(4):1304\u20131314."},{"issue":"1","key":"b20","series-title":"J Neurosurg","first-page":"154","article-title":"Surgical anatomy of the superior hypophyseal artery and its relevance for endoscopic endonasal surgery","volume":"131","author":"Truong HQ","year":"2018","unstructured":"Truong HQ, Najera E, Zanabria-Ortiz R. Surgical anatomy of the superior hypophyseal artery and its relevance for endoscopic endonasal surgery. J Neurosurg. 2018;131(1):154\u2013162."},{"issue":"1","key":"b21","series-title":"J Neurosurg","first-page":"141","article-title":"Bilateral coagulation of inferior hypophyseal artery and pituitary transposition during endoscopic endonasal interdural posterior clinoidectomy: do they affect pituitary function?","volume":"131","author":"Truong HQ","year":"2018","unstructured":"Truong HQ, Borghei-Razavi H, Najera E,  Bilateral coagulation of inferior hypophyseal artery and pituitary transposition during endoscopic endonasal interdural posterior clinoidectomy: do they affect pituitary function?. J Neurosurg. 2018;131(1):141\u2013146."}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/aop\/article-10.3171-2024.6.JNS24606\/article-10.3171-2024.6.JNS24606.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/aop\/article-10.3171-2024.6.JNS24606\/article-10.3171-2024.6.JNS24606.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/aop\/article-10.3171-2024.6.JNS24606\/article-10.3171-2024.6.JNS24606.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,1]],"date-time":"2025-03-01T01:40:38Z","timestamp":1740793238000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/aop\/article-10.3171-2024.6.JNS24606\/article-10.3171-2024.6.JNS24606.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,1]]},"references-count":21,"URL":"https:\/\/doi.org\/10.3171\/2024.6.jns24606","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,1]]}}}