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

• Published in: Neurology India Vol. 69; no. 4; pp. 829 - 832
• Main Authors: Srivastava, Arun, Mishra, Shashwat, Kumar, Ashutosh, Nangarwal, Bhavan, Das, Kuntal, Bhaisora, Kamlesh, Verma, Pawan, Jaiswal, Awadhesh, Behari, Sanjay
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer India Pvt. Ltd 01.07.2021; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd
• Subjects: Cadaver; Cavernous Sinus; Health aspects; Humans; Methods; Microsurgery; Nervous system; Neurosurgeons; Neurosurgical Procedures; Skull; Skull Base; Sphenoid Bone; Surgery; India; separation of the Dural duplication and the Extra dural anterior clenoid process (EACP) drilling is mandatory for treading in the area of the Anterolateral skull base; FTDF; extradural clinoidectomy; skull base; Cadaveric; unlockingKey Message: The Fronto-temporal dural fold (FTDF) cutting; unlocking
• ISSN: 0028-3886; 1998-4022
• DOI: 10.4103/0028-3886.325332

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.