Caroticoclinoid Bar: A Systematic Review and Meta-Analysis of Its Prevalence and Potential Implications in Cerebrovascular and Skull Base Surgery.

Caroticoclinoid bar Caroticoclinoid foramen Caroticoclinoid ring Clinoidectomy

Journal

World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275

Informations de publication

Date de publication:
Apr 2019
Historique:
received: 01 11 2018
revised: 31 12 2018
accepted: 02 01 2019
medline: 25 1 2019
pubmed: 25 1 2019
entrez: 25 1 2019
Statut: ppublish

Résumé

The presence of a caroticoclinoid bar (CCB) has been implicated in both transcranial and endonasal surgery. Its morphology reflects differences in the microsurgical anatomy of the parasellar area and its manipulation during anterior or middle clinoidectomy can result in internal carotid artery injury. Although adjustment of the surgical technique according to the CCB anatomic variants is required for safe surgical access to the paraclinoid region, a review indicated the lack of a systematic assortment of reported data regarding the prevalence of the CCB. Thus, our objective was to systematically review and document the prevalence of the CCB and its anatomic variations. Three databases were systematically reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement through August 2018 to identify relevant studies. A total of 27 reports (7521 subjects or specimens, 14,449 sides) were included in the present meta-analysis. The overall pooled prevalence of the CCB was 32.6% (95% confidence interval [CI], 26.6%-38.8%) when measured in the subjects or specimens and 23.6% (95% CI, 19.7%-27.6%) when measured in each side. The overall prevalence of the CCB reported from imaging studies was 23.1% (95% CI, 8.9%-41.4%) for the subjects/specimens and 18.7% (95% CI, 12.6%-25.7%) for each side. The presence of the CCB was slightly more prevalent (P = 0.050) on the right side. Our results showed a considerable prevalence of the CCB, with lower prevalence rates found among imaging studies. Although meticulous preoperative investigation is mandatory, surgeons treating patients with parasellar pathologic entities should always be vigilant regarding the CCB.

Sections du résumé

BACKGROUND BACKGROUND
The presence of a caroticoclinoid bar (CCB) has been implicated in both transcranial and endonasal surgery. Its morphology reflects differences in the microsurgical anatomy of the parasellar area and its manipulation during anterior or middle clinoidectomy can result in internal carotid artery injury. Although adjustment of the surgical technique according to the CCB anatomic variants is required for safe surgical access to the paraclinoid region, a review indicated the lack of a systematic assortment of reported data regarding the prevalence of the CCB. Thus, our objective was to systematically review and document the prevalence of the CCB and its anatomic variations.
METHODS METHODS
Three databases were systematically reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement through August 2018 to identify relevant studies.
RESULTS RESULTS
A total of 27 reports (7521 subjects or specimens, 14,449 sides) were included in the present meta-analysis. The overall pooled prevalence of the CCB was 32.6% (95% confidence interval [CI], 26.6%-38.8%) when measured in the subjects or specimens and 23.6% (95% CI, 19.7%-27.6%) when measured in each side. The overall prevalence of the CCB reported from imaging studies was 23.1% (95% CI, 8.9%-41.4%) for the subjects/specimens and 18.7% (95% CI, 12.6%-25.7%) for each side. The presence of the CCB was slightly more prevalent (P = 0.050) on the right side.
CONCLUSIONS CONCLUSIONS
Our results showed a considerable prevalence of the CCB, with lower prevalence rates found among imaging studies. Although meticulous preoperative investigation is mandatory, surgeons treating patients with parasellar pathologic entities should always be vigilant regarding the CCB.

Identifiants

DOI: 10.1016/j.wneu.2019.01.017 PMID: 30677570
pubmed: 30677570
pii: S1878-8750(19)30107-X
doi: 10.1016/j.wneu.2019.01.017
pii:
doi:

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

267-276

Informations de copyright

Copyright © 2019 Elsevier Inc. All rights reserved.

Auteurs

Georgios P Skandalakis (GP)

Athens Microneurosurgery Laboratory, Athens, Greece; Department of Neurosurgery, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Department of Anatomy and Surgical Anatomy, National and Kapodistrian University of Athens School of Medicine, Athens, Greece. Electronic address: gskandalakis@med.uoa.gr.

Christos Koutsarnakis (C)

Athens Microneurosurgery Laboratory, Athens, Greece; Department of Neurosurgery, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Department of Anatomy and Surgical Anatomy, National and Kapodistrian University of Athens School of Medicine, Athens, Greece.

Nikos Pantazis (N)

Department of Hygiene, Epidemiology, and Medical Statistics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece.

Aristotelis Kalyvas (A)

Athens Microneurosurgery Laboratory, Athens, Greece; Department of Neurosurgery, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Department of Anatomy and Surgical Anatomy, National and Kapodistrian University of Athens School of Medicine, Athens, Greece.

Spyridon Komaitis (S)

Athens Microneurosurgery Laboratory, Athens, Greece; Department of Neurosurgery, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Department of Anatomy and Surgical Anatomy, National and Kapodistrian University of Athens School of Medicine, Athens, Greece.

Evgenia Lani (E)

Athens Microneurosurgery Laboratory, Athens, Greece; Department of Neurosurgery, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Department of Anatomy and Surgical Anatomy, National and Kapodistrian University of Athens School of Medicine, Athens, Greece.

Evangelos Drosos (E)

Athens Microneurosurgery Laboratory, Athens, Greece; Department of Neurosurgery, National and Kapodistrian University of Athens School of Medicine, Athens, Greece.

Theodosis Kalamatianos (T)

Athens Microneurosurgery Laboratory, Athens, Greece.

Constantinos G Hadjipanayis (CG)

Department of Neurosurgery, Icahn School of Medicine at Mount Sinai and Mount Sinai Beth Israel, Mount Sinai Health System, New York, New York, USA.

Konstantinos Natsis (K)

Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.

George Stranjalis (G)

Athens Microneurosurgery Laboratory, Athens, Greece; Department of Neurosurgery, National and Kapodistrian University of Athens School of Medicine, Athens, Greece.

Maria Piagkou (M)

Athens Microneurosurgery Laboratory, Athens, Greece; Department of Anatomy and Surgical Anatomy, National and Kapodistrian University of Athens School of Medicine, Athens, Greece.

Classifications MeSH