Georgios P Skandalakis1, Christos Koutsarnakis2, Nikos Pantazis3, Aristotelis Kalyvas2, Spyridon Komaitis2, Evgenia Lani2, Evangelos Drosos4, Theodosis Kalamatianos5, Constantinos G Hadjipanayis6, Konstantinos Natsis7, George Stranjalis4, Maria Piagkou8. 1. 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. 2. 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. 3. Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. 4. Athens Microneurosurgery Laboratory, Athens, Greece; Department of Neurosurgery, National and Kapodistrian University of Athens School of Medicine, Athens, Greece. 5. Athens Microneurosurgery Laboratory, Athens, Greece. 6. Department of Neurosurgery, Icahn School of Medicine, Mount Sinai Health System, New York, NY; Department of Neurosurgery, Icahn School of Medicine Mount Sinai Beth Israel, Mount Sinai Health System, New York, New York. 7. Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece. 8. Athens Microneurosurgery Laboratory, Athens, Greece; Department of Anatomy and Surgical Anatomy, National and Kapodistrian University of Athens School of Medicine, Athens, Greece.
Abstract
BACKGROUND: The caroticoclinoid bar (CCB) is implicated in both transcranial and endonasal surgery. Its morphology reflects differences in the microsurgical anatomy of the parasellar area while its manipulation during an anterior or middle clinoidectomy can result in ICA injury. Although safe surgical access to the paraclinoidal region is related to adjustment of surgical technique according to CCB anatomical variants, a review of the literature indicates the lack of a systematic assortment of published data regarding the prevalence of this variable structure. As such the topic needs further investigation. OBJECTIVE: To systematically review and document the prevalence of the CCB and its anatomic variations. METHODS: 3 Databases were systematically reviewed according to the PRISMA statement through August of 2018 for the identification of relevant studies. RESULTS: A total of 27 articles (7,521 subjects/specimens, 14,449 sides) were included in this meta-analysis. The overall pooled prevalence of the CCB was 32.6% (95% CI 26.6% - 38.8%) when measured over subjects/specimens and 23.6% (95% CI 19.7% - 27.6%) when measured over sides. Overall prevalence of the CCB reported from imaging studies was 23.1% (95% CI 8.9% - 41.4%) when measured over subjects/specimens and 18.7% (95% CI 12.6% - 25.7%) when measured over sides. Moreover, the CCB was slightly more prevalent (p = 0.050), on the right side. CONCLUSION: Our results indicate considerable CCB prevalence rates and that imaging studies report lower prevalence rates. Although meticulous preoperative investigation is mandatory, surgeons carrying for patients with parasellar pathologies should always be vigilant about this structure.
BACKGROUND: The caroticoclinoid bar (CCB) is implicated in both transcranial and endonasal surgery. Its morphology reflects differences in the microsurgical anatomy of the parasellar area while its manipulation during an anterior or middle clinoidectomy can result in ICA injury. Although safe surgical access to the paraclinoidal region is related to adjustment of surgical technique according to CCB anatomical variants, a review of the literature indicates the lack of a systematic assortment of published data regarding the prevalence of this variable structure. As such the topic needs further investigation. OBJECTIVE: To systematically review and document the prevalence of the CCB and its anatomic variations. METHODS: 3 Databases were systematically reviewed according to the PRISMA statement through August of 2018 for the identification of relevant studies. RESULTS: A total of 27 articles (7,521 subjects/specimens, 14,449 sides) were included in this meta-analysis. The overall pooled prevalence of the CCB was 32.6% (95% CI 26.6% - 38.8%) when measured over subjects/specimens and 23.6% (95% CI 19.7% - 27.6%) when measured over sides. Overall prevalence of the CCB reported from imaging studies was 23.1% (95% CI 8.9% - 41.4%) when measured over subjects/specimens and 18.7% (95% CI 12.6% - 25.7%) when measured over sides. Moreover, the CCB was slightly more prevalent (p = 0.050), on the right side. CONCLUSION: Our results indicate considerable CCB prevalence rates and that imaging studies report lower prevalence rates. Although meticulous preoperative investigation is mandatory, surgeons carrying for patients with parasellar pathologies should always be vigilant about this structure.