3D-exoscopic extradural Hakuba-Dolenc approach with manipulation of pneumatized anterior clinoid process for the prevention of cerebrospinal fluid leakage: how I do it.

Abstract

Microsurgical skull base technique continues to be a crucial component in repairing intracranial vascular anomalies and resecting massive lesions. We described a technical modification to manipulate pneumatized anterior clinoid process (pACP) during extradural Hakuba-Dolenc approach for the precaution of postoperative cerebrofluid leakage under the direct visualization of 3D digital Aeos exoscope. The interdural dissection of lateral wall of cavernous sinus followed by ACP removal using hybrid (drilling & biting) technique was performed. A supplemental video of surgical details was also presented. The hybrid clinoidectomy technique has been shown to be an effective method for preventing cerebrospinal fluid leakage, particularly during surgical manipulations involving pneumatized skull base bone.