Pterional Craniotomy for Resection of Clinoidal Meningioma Associated With an Aerated Anterior Clinoid Process: 2-Dimensional Operative Video.

Extradural removal of the clinoid performed prior to resection of clinoidal meningiomas has been advocated as a way to facilitate devascularization of the tumor and provide early identification and/or decompression of adjacent neurovascular structures. A small number of video publications exist in the literature that provides useful guidance to surgeons preparing for resection of clinoidal region meningiomas.1-3 However, none of these videos portray the variable anatomy associated with an aerated clinoid process. This known anatomical variant can increase the risk profile associated with resection of clinoidal meningomas-especially with regards to postoperative cerebrospinal fluid (CSF) fistula.  In this video publication, we discuss the care of a 54 yr-old male who presented with visual deterioration in the right eye. Magnetic resonance imaging (MRI) revealed findings consistent with a right clinoidal meningioma. Computed tomography demonstrated bilateral aeration of the anterior clinoid processes. The patient was taken to the operating room for right pterional craniotomy for resection of the neoplasm. Edited, intraoperative 2-dimensional-video demonstrates the variable anatomy encountered during removal of an aerated clinoid process. Relevant steps associated with subsequent tumor resection are summarized. Following resection, MRI obtained in the early postoperative period demonstrated gross total resection of the neoplasm without untoward finding. The patient noted marked improvement in his vision following surgery and did not suffer any complications relating to postoperative CSF fistula. Full patient consent for photography and/or recording of other forms of video/imaging was obtained in the preoperative period.