Extradural anterior clinoidectomy and aneurysm clipping using transcranial neuroendoscopic approach A case report

Rationale: Anterior clinoidectomy is an important technique for neurovascular and skull base surgery. Until now, extradural anterior clinoidectomies have been performed under a microscope in almost all clinical cases, with only one clinical case performed an extradural pathological anterior clinoid process resection using neuroendoscopy. Additionally, no normal ACP resections have been performed extradurally via neuroendoscopy, especially for aneurysms. We tried to perform extradural anterior clinoidectomies by neuroendoscopy. Patient concerns: A 63-year-old woman was admitted to hospital presented with sudden onset of headache without any accompanying neurological deficit. A computed tomography (CT) scan of the head revealed a subarachnoid hemorrhage, which was positioned mainly in the left slyvian fissure and interpeduncular and basilar cisterns. Diagnoses: 1. Left side posterior communicating artery aneurysm; 2. subarachnoid hemorrhage. Interventions: Extradural anterior clinoidectomy and aneurysm clipping were performed using transcranial neuroendoscopic approaches. Outcomes: The patient recovered well after the procedure, and the post-operative image view revealed that the ACP had been removed and that the clip was located just at the ACP area. Lessons: This case provided the first evidence that extradural anterior clinoidectomy could be performed by transcranial neuroendoscopic approach.