• Marcos Chiarullo, Jorge Mura, Pablo Rubino, Nícollas Nunes Rabelo, Rafael Martinez-Perez, Eberval Gadelha Figueiredo, and Albert Rhoton.
• Department of Neurosurgery, University of Florida, College of Medicine, Gainesville, Florida, USA; Department of Neurosurgery, El Cruce Hospital, Florencio Varela, Buenos Aires, Argentina.
• World Neurosurg. 2019 Sep 1; 129: e502-e513.

BackgroundSeveral diseases that involve the optic canal or its contained structures may cause visual impairment. Several techniques have been developed to decompress the optic nerve.ObjectiveTo describe minimally invasive extradural anterior clinoidectomy (MiniEx) for optic nerve decompression, detail its surgical anatomy, present clinical cases, and established a proof of concept.MethodsAnatomic dissections were performed in cadaver heads to show the surgical anatomy and to show stepwise the MiniEx approach. In addition, these surgical concepts were applied to decompress the optic nerve in 6 clinical cases.ResultsThe MiniEx approach allowed the extradural anterior clinoidectomy and a nearly 270° optic nerve decompression using the no-drill technique. In the MiniEx approach, the skin incision, dissection of the temporal muscle, and craniotomy were smaller and provided the same extent of exposure of the optic nerve, anterior clinoid process, and superior orbital fissure as that usually provided by standard techniques. All patients who underwent operation with this technique had improved visual status.ConclusionsThe MiniEx approach is an excellent alternative to traditional approaches for extradural anterior clinoidectomy and optic nerve decompression. It may be used as a part of more complex surgery or as a single surgical procedure.Copyright © 2019 Elsevier Inc. All rights reserved.

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