Most IC-PC ANs could be safely clipped via the pterional approach. However, if ANs are larger or the anterior clinoid process (ACP) can hide the anatomy at the proximal neck, clinoidectomy is sometimes necessary for complete exposure and safe clipping.
We examined 57 cases of IC-PC ANs treated with clipping. The ACP was resected in 11 of the 57 cases, which included different techniques for extradural resection for seven cases and intradural resection for four cases, respectively.
We recommend extradural clinoidectomy for all ANs close to 1 cm. However, if an AN is less than 1 cm, and satisfactory proximal carotid control or visualization of the neck is obscured by the ACP, then intradural partial clinoidectomy is an effective alternative method.