Nuances of Anterior Clinoidectomy in the Presence of a Fully Developed Carotico-Clinoid Foramen: Technical Illustration Through a Case of Paraclinoid Aneurysm Clipping

Anterior clinoidectomy (AC) is a critical step in the surgery of complex aneurysms and tumors of the parasellar region. However, anatomical variations of the anterior clinoid process (ACP) present unique surgical challenges, often mandating specific operative considerations. A unique anatomical variation, namely the carotico-clinoidal foramen (CCF), poses specific challenges in this context. We present the surgical steps and rationale of the “extra-intradural” technique for ACP removal as a means of safely managing the CCF, with an illustrative case of a thrombosed right-sided superior hypophyseal artery aneurysm in a 59-year-old lady. This technique is safe and specifically suited for AC in the presence of CCF, aimed at avoiding the potential complications while retaining the advantages of a complete AC.