Extradural anterior clinoidectomy: Technical nuances from a learner's perspective

BACKGROUND: Extradural removal of the anterior clinoid process (ACP) is a crucial step in the proper surgical exposure of various pathologies in and around the central skull base. Since the pioneering description by Dolenc, the technique of extradural clinoidectomy has undergone several refinements in the light of improved understanding of microsurgical anatomy and maturation of neurosurgical techniques. Mastery of the surgical nuances involved in performing this surgical exercise will allow the young neurosurgeon to execute this step without undue reluctance and trepidation. OBJECTIVE: This paper is an attempt to describe in detail, from a learner's viewpoint, the sequence of maneuvers involved in extradural removal of the ACP. MATERIALS AND METHODS: The standard pterional approach and extradural anterior clinoidectomy was performed on four sides of two formalin fixed and latex injected cadaver heads. Important steps were photographed through the surgical microscope. CONCLUSION: An accurate understanding of the microsurgical anatomy of this region and the surgical nuances relevant to extradural clinoidectomy helps simplify the complexity of this surgical step.