Nalan Çiçek ÖZDÖL, Çağatay ÖZDÖL, Tolga GEDİZ

Türk Nüfusundaki Anterior Klinoid Proses Ölçümlerinin Bilgisayarlı Tomografik Çalışması

Amaç: Sellar bölge tümörlerinin ya da anevrizmalarının cerrahi olarak tedavisi sırasında genellikle ortadan kaldırılan anterior klinoid proses, cerrahiöneme sahiptir. Etkili klinoidektomi için, bir beyin cerrahı anterior klinoid prosesin anatomik varyasyonları hakkında önceden bilgi sahibi olmalıdır.Bu çalışmanın amacı, Türk nüfusundaki Anterior klinoid proses şekil, boyut, pnömotizasyonu ve varyasyonlarını araştırmaktır.Gereç ve Yöntem: Çalışmaya, 19 ile 86 yaşları arasındaki 500 olgunun (270 erkek, 230 kadın) bilgisayarlı tomografi görüntüleri dahil edildi. Anteriorklinoid prosesin boyutları, anterior klinoid proses pnömatizasyonu varlığı ve pnömatizasyon tipleri (1, 2 veya 3) değerlendirildi.Bulgular: Anterior klinoid prosesin bazal uzunluğu ve genişliği sağda 11,97±1,90 ve 6,8±1,58 mm iken, solda 11,73±1,71 ve 7,94±1,81 mm bulundu.ACP pnömatizasyonu, sağ %12, sol %12 ve bilateral %4 olarak saptandı. En sık saptanan pnömatizasyon tipleri sağ pnömatizasyon için tip 1 (%50),sol (%59) ve bilateral (%40) pnömatizasyon için tip 2 pnömatizasyon idi.Sonuç: Kavernöz sinüs ve sellar bölgenin nörovasküler oluşumlarına yaklaşımlar sırasında anterior klinoid prosesin anatomik varyasyonları göz önünde bulundurulmalıdır.

A Computed Tomographic Study of the Anterior Clinoid Process Measurements in Turkish Population

Objectives: Anterior clinoid process which is partially or totally takes out in the surgery of sellar region has a great surgical importance. For effective clinoidectomy, a neurosurgeon should have the prior knowledge of anatomical variations of anterior clinoid process. The aim of this study was to investigate the dimensions, pneumatization and variation of anterior clinoid process in Turkish population. Materials and Methods: A Multidetector Computerized Tomography images of 500 subjects (270 male, 230 female), between 19 and 86 years of age, were included in the study. Dimensions of anterior clinoid process, presence and types of pneumatization of the anterior clinoid process and pneumatization types (1, 2 or 3) were evaluated. Results: The average basal width and length of anterior clinoid process on right side was 11.97±1.90 and 6.8±1.58 mm, respectively, and on the left side it was 11.73±1.71 and 7.94±1.81 mm, respectively. Right, left and bilateral pneumatization were detected in 12%, 12% and 4% respectively. The most commonly seen types of pneumatization of anterior clinoid process were type 1 (50%) for right pneumatization and type 2 pneumatization for left (59%) and bilateral (40%) pneumatization. Conclusion: The anatomic variations of the anterior clinoid process should be considered in the approaches to the cavernous sinus and the sellar region.

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Standring S, Borley NR, Collins P. et al. The anatomical basis of clinical practice. Chapter 27 Intracranial region: Greys Anatomy 40th edition Churchill Livingstone Elsevier; 2008. 423-424 p.
Andaluz N, Beretta F, Bernucci C, et al. Evidence for the improved exposure of the ophthalmic segment of the internal carotid artery after anterior clinoidectomy: morphometric analysis. Acta Neurochir (Wien). 2006;148:971-975; discussion 975-976.
Evans JJ, Hwang YS, Lee JH. Pre- versus post-anterior clinoidectomy measurements of the optic nerve, internal carotid artery, and opticocarotid triangle: a cadaveric morphometric study. Neurosurgery. 2000;46:1018- 1021; discussion 1021-103.
Hayashi N, Masuoka T, Tomita T, et al. Surgical anatomy and efficient modification of procedures for selective extradural anterior clinoidectomy. Minim Invasive Neurosurg. 2004;47:355-358.
Huynh-Le P, Natori Y, Sasaki T. Surgical anatomy of the ophthalmic artery: its origin and proximal course. Neurosurgery. 2005;57(Suppl 4):236-241; discussion 236-241.
Dolenc VV. A combined epi- and subdural direct approach to carotidophthalmic artery aneurysms. J Neurosurg. 1985;62:667-672.
Matsuyama T, Shimomura T, Okumura Y, et al. Mobilization of the internal carotid artery for basilar artery aneurysm surgery. Technical note. J Neurosurg. 1997;86:294-296.
Sato S, Sato M, Oizumi T, et al. Removal of anterior clinoid process for basilar tip aneurysm: clinical and cadaveric analysis. Neurol Res. 2001;23:298-303.
Seoane E, Rhoton AL Jr, de Oliveira E. Microsurgical anatomy of the dural collar (carotid collar) and rings around the clinoid segment of the internal carotid artery. Neurosurgery. 1998;42:869-884.
Abuzayed B, Tanriover N, Biceroglu H, et al. Pneumatization degree of the anterior clinoid process: a new classification. Neurosurg Rev. 2010;33:367- 373.
Noguchi A, Balasingam V, Shiokawa Y, et al. Extradural anterior clinoidectomy. Technical note. J Neurosurg. 2005;102:945-950.
Nutik SL. Removal of the anterior clinoid process for exposure of the proximal intracranial carotid artery. J Neurosurg. 1988;69:529-534.
Yonekawa Y, Ogata N, Imhof HG, et al. Selective extradural anterior clinoidectomy for supra- and parasellar processes. Technical note. J Neurosurg. 1997;87:636-642.
Cheverud JM. Phenotypic, Genetic, and Environmental Morphological Integration in the Cranium. Evolution. 1982;36:499-516.
Ng MY, Sham PC, Paterson AD, et al. Effect of environmental factors and gender on the heritability of bone mineral density and bone size. Ann Hum Genet. 2006;70:428-438.
Dagtekin A, Avci E, Uzmansel D, et al. Microsurgical anatomy and variations of the anterior clinoid process. Turk Neurosurg. 2014;24:484-493.
Lee HY, Chung IH, Choi BY. et al. Anterior clinoid process and optic strut in Koreans. Yonsei Med J. 1997;38:151-154.
Gupta N, Ray B, Ghosh S. A study on anterior clinoid process and optic strut with emphasis on variations of caroticoclinoid foramen. Nepal Med Coll J. 2005;7:141-144.
Huynh-Le P, Natori Y, Sasaki T. Surgical anatomy of the anterior clinoid process. J Clin Neurosci. 2004;11:283-287.
Arslan H, Aydinlioglu A, Bozkurt M, et al. Anatomic variations of the paranasal sinuses: CT examination for endoscopic sinus surgery. Auris Nasus Larynx. 1999;26:39-48.
Bolger WE, Butzin CA, Parsons DS. Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope. 1991;101:56-64.
Citardi MJ, Gallivan RP, Batra PS, et al. Quantitative computer-aided computed tomography analysis of sphenoid sinus anatomical relationships. Am J Rhinol. 2004;18:173-178.
Mikami T, Minamida Y, Koyanagi I, et al. Anatomical variations in pneumatization of the anterior clinoid process. J Neurosurg. 2007;106:170- 174.
Sirikci A, Bayazit YA, Bayram M, et al. Variations of sphenoid and related structures. Eur Radiol. 2000;10:844-848.
Avci E, Bademci G, Ozturk A. Microsurgical landmarks for safe removal of anterior clinoid process. Minim Invasive Neurosurg. 2005;48:268-272.