Microsurgical anatomy of the dorsal clinoidal space: implications for endoscopic endonasal parasellar surgery
Stanford researchers have detailed the first-ever anatomic description of the dorsal clinoidal space, a region that has historically been difficult to access during skull base surgery.
February 28, 2022
The dorsal clinoidal space (DCS), an area located on the back side of the internal carotid artery (ICA), is an important region in skull base surgery. However, the DCS is a relatively unexplored region because it is difficult to access using a transcranial approach. With the development of endoscopic endonasal surgery, this space has gained increasing significance in treating invasive pituitary adenomas and other parasellar lesions.
In this study, published in the February 2022 issue of the Journal of Neurosurgery, the authors provided the first detailed and precise anatomical description of the DCS from the endoscopic endonasal approach as well as from the transcranial perspective. The authors described technical nuances that may enable surgeons to safely expose the DCS and remove invasive adenomas, thereby increasing total resection rates and minimizing the risk of injury to neurovascular structures.
Illustration of the DCS from the endoscopic endonasal view (Joshua Klein/Medbilden)
The surgical anatomy and technique described in the article are applicable for many of the pathologies treated at the world-renowned Stanford Skull Base Center under the leadership of Juan Fernandez-Miranda, MD, such as invasive pituitary adenomas, particularly functional types. The authors note that knowledge of the DCS anatomy is also clinically relevant to other parasellar conditions, including meningiomas and aneurysms.
The study authors are Yuanzhi Xu, MD, Maximiliano Alberto Nunez, MD, Ahmed Mohyeldin, MD, PhD, Vera Vigo, MD, Ying Mao, MD, Aaron A. Cohen-Gadol, MD, MSc, MBA, and Juan C. Fernandez-Miranda, MD.
The Stanford Neurosurgical Training and Innovation Center, led by Dr. Fernandez-Miranda, is a translational effort using the study of microsurgical dissection to introduce novel anatomical concepts and innovative surgical technique into real surgical practice.
This research work was made in collaboration with The Neurosurgical Atlas, the largest nonprofit organization for neurosurgical education and research in the world.
Read more about the paper: https://thejns.org/view/journals/j-neurosurg/aop/article-10.3171-2021.12.JNS211974/article-10.3171-2021.12.JNS211974.xml
Juan Fernandez-Miranda, MD, is the senior author of the study.