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Treading Toward Anterolateral Skull Base by Unlocking the Frontotemporal Dural Fold Along with Extradural Clinoidectomy: Translation from A Cadaver to Clinical Scenario

2021; Medknow; Volume: 69; Issue: 4 Linguagem: Inglês

10.4103/0028-3886.325332

1998-4022

ArunK Srivastava, Shashwat Mishra, Ashutosh Kumar, Bhavan Nangarwal, Kuntal K Das, KamleshS Bhaisora, Pawan Kumar Verma, AwadheshK Jaiswal, Sanjay Behari,

Pituitary Gland Disorders and Treatments

Background and Introduction: Unlocking of the frontotemporal dural fold (FTDF) and extradural removal of the anterior clinoid process (EACP) are challenging but mandatory skills for micro-neurosurgeons. Despite the presence of an extensive body of literature on this subject, the translation of this cadaveric and 3D simulation to a real patient turns out to be a very demanding and difficult task.Objective: This video is aimed to address the surgical nuances and major adjustments necessary in the unlocking of the FTDF and extradural ACP removal in an actual case for an early-career neurosurgeon.Surgical Technique: A 40-year lady presented with features of acromegaly with radiological evidence of significant component of the tumor in the right cavernous sinus along with sellar suprasellar component. To achieve a good hormonal control, a complete tumor excision was required, which was achieved with FTDF and EACP removal. The cavernous sinus was approached through the Parkinson's triangle.Results: The patient had uneventful recovery and good hormonal control at the 3-month follow-up.Conclusion: FTDF unlocking and EACP are elegant procedures and need to be learned by all neurosurgeons. This article will provide excellent teaching material for young neurosurgeons.