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Morphometric Analysis of the Middle Clinoid Using Maxillofacial CT Scans. Christopher Miller MD; Roukoz B. Chamoun MD University of Kansas

Introduction Results References, continued The interest in detailed anatomy of Axial Length and Width Saggital Length and Base The prevalence of the MCP was 2. Spektor S, Dotan S, Mizrahi CJ. the sellar and parasellar region has Width 30.7% in males and 42.7% in Safety of drilling for clinoidectomy and resurged recently due to the wide females. Of subjects found to have unroofing in anterior clinical applications of the expanded an MCP, 41.8% were ring forming base surgery. Acta Neurochir (Wien). endoscopic approaches to the skull while 76.4% were pneumatized. 2013 Jun;155(6):1017-24. base. The middle clinoid process Quantitatively the average base (MCP) is a bony structure that can diameter was 4.6±1.4mm in the axial 3. Inoue T, Rhoton AL Jr, Theele D, affect wide endoscopic exposure of plane and 5.0±1.8mm in the sagittal Barry ME. Surgical approaches to the the sellar and parasellar region. The plane, average maximum length was cavernous sinus:a microsurgical study. purpose of this project is to study and 4.7±1.7mm, average distance from Neurosurgery. 1990 Jun;26(6):903- analyze the anatomical variations of midline was 5.9±2.3mm, average 32. the MCP in the general population distance from the clival sellar angle using CT scans. was 10.6±3.3mm, average angle in Demonstration of methods for the sagittal plane was 91.0±15.4º, 4. Wang J, Wang R, Lu Y, Yao Y, Qi S. and average angle in the axial plane Anatomical analysis on the lateral axial lenth and width Demonstration of length and base was 45.2±15.5º. There were no window of the : a study on width measurements in the Methods measurement in the axial view significant differences in gender, age, 530 adult dry skull base specimens. 150 maxillofacial CT scans were sagittal view. ethnicity, or laterality. There was a Int J Med Sci. 2014 Jan 3;11(2):134- reviewed to characterize the MCP. Axial Angle and Midline significant increase in the prevalence 41. doi: 10.7150/ijms.7137. Only adult patients with no pathology distance Sagittal Angle and SCJ of MCPs in whites as compared to eCollection 2014. in sellar region that could potentially measurement African Americans or blacks (41.3% cause changes in the morphology of vs 19.4%, p = .02). Additionally, 5. Cheng Y, Wang C, Yang F, Duan Y, the MCP. Measurements were made when comparing males to females, Zhang S, Wang J. Anterior clinoid in the axial and sagittal planes to males showed significantly larger process and the surrounding determine maximum length, midline distance (7.0±2.2mm vs structures. J Craniofac Surg. 2013 diameter, distances from key 5.2±2.1mm, p = .0001) and saggital Nov;24(6):2098-102. structures and angulation of the MCP. angle (50.4±15.6º vs 41.6 ± 14.5º, Charts were reviewed for p=.01). demographic data including age, sex, 6. Dagtekin A, Avci E, Uzmansel D, race, and ethnicity. Kurtoglu Z, Kara E, Uluc K, Akture E, Baskaya MK. Microsurgical anatomy

Conclusions and variations of the anterior clinoid A clear understanding of the sellar process. Turk Neurosurg. Demonstration of angle and Learning Objectives and parasellar anatomy is crucial for 2014;24(4):484-93. midline distance measurements Demonstration of angle and SCJ By conclusion if this session, performing successful and safe participants should be able to: 1) in the axial view measurement in the sagittal view. expanded endoscopic approaches to 7. Gupta N, Ray B, Ghosh S. A study Identify the middle clinoid process on treat skull base pathologies. This SCJ - Sella Clival Junction. on and optic CT scans, 2) Understand the basic study provides a quantitative strut with emphasis on variations of morphology and variants of the anatomical characterization of the caroticoclinoid foramen. Nepal Med middle clinoid process, 3) Understand MCP in the general population. Coll J. 2005;7(2):141-144. 23. how the presence and morphology of Careful review of CT imaging is the middle clinoid process can impact necessary for safe and effective the transphenoidal surgical approach. surgery. 8. Erturk M, Kayalioglu G, Govsa F. Anatomy of the clinoidal region with special emphasis on the caroticoclinoid foramen and interclinoid References osseous bridge in a recent Turkish 1. Peris-Celda M, Kucukyuruk B, population. Neurosurg Rev. Monroy-Sosa A, Funaki T, Valentine 2004;27(1):22-26. R, Rhoton AL Jr. The recesses of the sellar wall of the and their intracranial relationships. Neurosurgery. 2013 Dec;73(2 Suppl Operative):117-31;