Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 74104

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : June | Volume : 17 | Issue : 6 | Page : AC01 - AC04 Full Version

Incidence of Ossification of Caroticoclinoid Ligament in Dry Adult Human Skulls with its Surgical Implications: A Cross-sectional Study from Telangana Region, India


Published: June 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/63911.17997
K Ephraim Vikram Rao, Rama Devi Avula, Parimala Sirikonda, Rajasekhar Katikireddi

1. Assistant Professor, Department of Anatomy, Gandhi Medical College, Secunderabad, Hyderabad, Telangana, India. 2. Associate Professor, Department of Anatomy, Gandhi Medical College, Secunderabad, Hyderabad, Telangana, India. 3. Assistant Professor, Department of Anatomy, Osmania Medical College, Hyderabad, Telangana, India. 4. Assistant Professor, Department of Anatomy, Gandhi Medical College, Secunderabad, Hyderabad, Telangana, India.

Correspondence Address :
Dr. K Ephraim Vikram Rao,
12-11-332, Warasiguda, Secunderabad, Hyderabad-500061, Telangana, India.
E-mail: dr.ephraimvikram@gmail.com

Abstract

Introduction: The caroticoclinoid ligament extends from the Anterior Clinoid Process (ACP) to the Middle Clinoid Process (MCP). Occasionally, it gets ossified and forms the caroticoclinoid foramen. Anterior clinoidectomy is a common surgical procedure to treat internal carotid artery aneurysms or pituitary tumours. Abnormal ossification of the caroticoclinoid ligament may lead to intraoperative or postoperative complications as it is not normally present.

Aim: To find out the incidence of ossification of the caroticoclinoid ligament in adult human skulls.

Materials and Methods: This was an observational cross-sectional study which was conducted in the Department of Anatomy at Gandhi Medical College, Hyderabad, India from January 2021 to February 2023. The study had included 100 dry adult human skulls with open vault were collected from the Department of Anatomy, Gandhi Medical College, Secunderabad; Osmania Medical College, Hyderabad; Bhaskar Medical College, Moinabad, Telangana, India. All the skulls were observed and skulls damaged in the clinoid regions were excluded from the study. The skulls were observed for the presence of any ossifications of the caroticoclinoid ligaments and the observations were noted. The qualitative data was presented as number and percentage was calculated. The data was recorded in Microsoft excel version 2021.

Results: The incidence of ossification of caroticoclinoid ligament was 8 (8%). The incidence was higher on right-side when compared to the left-side. Bilateral complete ossification of the caroticoclinoid ligament was observed in 2 (2%) skulls; bilateral incomplete ossification was observed in 2 (2%) skulls, unilateral complete ossification was observed in 2 (2%) skulls on the right-side. In one skull 1 (1%), complete ossification was observed on the right-side and incomplete ossification was observed on the left-side.

Conclusion: Knowledge of the ossification of the caroticoclinoid ligament is important for neurosurgeons, while performing anterior clinoidectomies or skull base surgeries. Radiological confirmation of the ossification of the caroticoclinoid ligament is essential to avoid complications.

Keywords

Carotid artery, Clinoidectomy, Internal, Paraclinoid, Sella turcica

The lesser wing of the sphenoid is an important landmark for neurosurgery. The medial projecting ends of the lesser wing of sphenoid are called ACP and the MCP are small projections present at lateral ends of the tuberculum sellae, the anterior boundary of the sella turcica. The ACP is connected to the MCP by a ligament called the caroticoclinoid ligament or sometimes by a dural fold (1). Sometimes this caroticoclinoid ligament or dural fold may undergo ossification and form caroticoclinoid foramen, as a bony bar which extends from the anterior to the MCP. The ossification of the caroticoclinoid foramen can be complete or incomplete (2). The internal carotid artery is a chief artery that supplies blood to the forebrain structures. After entering the cranial cavity, the artery passes through the cavernous sinus and curves up medial to the ACP. Here, the artery emerges through the dural roof of the cavernous sinus, where it is completely enclosed by the connective tissue (3). Any abnormal ossification of the dural folds or the caroticoclinoid ligaments may lead to internal carotid artery entrapment (4).

The surgical removal of ACP is called anterior clinoidectomy. It is performed to treat parasellar, proximal carotid region and skull base pathologies of the central part of the middle cranial fossa (5). Paraclinoid aneurysms of the internal carotid artery are usually treated by anterior clinoidectomy. This treatment procedure becomes more difficult when the caroticoclinoid foramen is present with ossification of caroticoclinoid ligament, causing a higher possibility of serious haemorrhage. Anterior clinoidectomy is one of the most critical surgical procedures done for the successful and safe management of aneurysms of the ophthalmic part of internal carotid artery and tumours located in the paraclinoid region and cavernous sinus (6). Proper knowledge of the bony bars or ossified caroticoclinoid ligaments is important for neurosurgeons while dealing with aneurysms of the internal carotid arteries in the intercavernous region and also while dealing with meningiomas of the tuberculum sellae (7). The incidence of ossification of the caroticoclinoid ligament ranged from 3-37.19% in different ethnic populations [8,9]. There is limited literature available concerning the incidence of the caroticoclinoid ligament ossification in the Telangana region (8). Thus, the present study was undertaken to find the incidence of ossification of the caroticoclinoid ligaments in Telangana region.

Material and Methods

The present study was an observational cross-sectional study conducted in the Department of Anatomy at Gandhi Medical College, Hyderabad from January 2021 to February 2023. The samples were collected from Department of Anatomy, Gandhi Medical College, Secunderabad; Osmania Medical College, Hyderabad, and Bhaskar Medical College, Moinabad, Telangana, India. The study included 100 skulls belonging to Telangana region.

Inclusion criteria: Dry adult human skulls with vault open were included in the present study.

Exclusion criteria: The skulls which were damaged or fractured at the anterior and the MCP and sella turcica were excluded from the study.

Study Procedure

The ACP and MCP were examined for any ossifications of the caroticoclinoid ligaments forming caroticoclinoid foramen. There are three types of connections which can exist between the ACP and MCP according to classification of Keyes JEL (10).

• Type 1 (Complete type): Formation of complete foramen without having any break.
• Type 2 (Contact type): Presence of a suture between the ACP and MCP.
• Type 3 (Incomplete type): Spicules of bone present between the ACP and MCP without any contact.

All the skulls were examined for any abnormal ossifications. The presence of caroticoclinoid foramen unilateral or bilateral was also recorded. All the findings were noted and photographed. The incidence was calculated.

Statistical Analysis

The quantitative data was presented as number and percentage. The data was recorded in MS excel version 2021 and the incidence was calculated.

Results

A total of 100 skulls were observed, 8 (8%) skulls had ossification of caroticoclinoid ligaments. Caroticoclinoid foramen was observed unilaterally in 3 (3%) skulls and bilaterally in 5 (5%) of the skulls. The incidence of ossification was observed to be high on the right-side. There were no skulls found with ossified caroticoclinoid ligament on the left-side alone (Table/Fig 1).

Type 1 or complete type was observed bilaterally in 2 (2%) of the skulls, in which one skull showed a thick bony bar extending from the ACP to MCP (Table/Fig 2) whereas in another skull on the right-side a thick bony bar was present, but on the left side, a thin bony plate was extending from the ACP to the MCP (Table/Fig 3).

Type 2 or contact type was not observed in any of the skulls. Type 3 or incomplete ossification of the caroticoclinoid ligament was observed in 2 (2%) skulls bilaterally (Table/Fig 4). Unilateral incomplete ossification of the caroticoclinoid ligament was observed in 3 (3%) skulls on the right-side only (Table/Fig 5). In 1 (1%) skull complete ossification of the caroticoclinoid ligament was observed on the right-side and incomplete ossification was observed on the left-side (Table/Fig 6).

Discussion

The caroticoclinoid ligament extends between the ACP and MCP. Ossification of this ligament forms the caroticoclinoid foramen. Keyes JEL described the boundaries of the caroticoclinoid foramen as follows: laterally- ACP; medially- the body of the sphenoid bone; posteriorly- a bony bridge extending between the ACP and MCP; and anteriorly- base of the lesser wing of the sphenoid bone (10). Ossification is a normal physiological process and is age dependent (11). But, the ossification of the caroticoclinoid ligament is not age-dependent as it was also observed in foetuses and infants. Hochstetter F and Kier EL reported that the ossified caroticoclinoid ligament forms the caroticoclinoid foramen and also the interclinoid osseous bridge in foetal and infant skulls. This explains that, the caroticoclinoid foramen is a developmental anomaly which exists from foetal life (12),(13). Studies suggest that the incidence of the caroticoclinoid foramen was more in cases with hormonal imbalance or disturbances, developmental disorders, criminals, and also epileptics (14). The internal carotid artery calibre is greater in the clinoid region, which could be a causative factor for headache due to compression of the internal carotid artery (15).

There are many clinical implications related to mineralisation of the caroticoclinoid ligament and the dural ligaments attached to the dorsum sellae. Especially while planning surgeries of pituitary gland, internal carotid artery at cavernous sinus and the sellar and parasellar regions (16),(17). Anterior clinoidectomy is a surgical procedure where the ACP is removed. It is performed for better access to the optic nerve, internal carotid artery and its branches. Ossification of the caroticoclinoid ligament whether complete or incomplete requires additional drilling and may need extra care while retracting the ACP (10),(18). Sometimes, the ACP may be pneumatised or may have variation in the bone density (19),(20). So care must be taken to avoid injury to the internal carotid artery and optic nerve. Preoperative radiological examination should be done to avoid injury to internal carotid artery, oculomotor nerve, and optic nerve (14),(21),(22).

In the present study, incidence of the ossification of caroticoclinoid ligament was observed in 8% skulls which was within the range of the other Indian studies. The incidence of the caroticoclinoid ligament ossification and formation of caroticoclinoid foramen had a range between 6 to 37% in the Indian population. In South India, the incidence was reported to be between 6 to 20%. The incidence of the caroticoclinoid ligament ossification was observed to vary with ethnicity (Table/Fig 7) (4),(8),(9),(10),(11),(14),(23),(24),(25),(26),(27).

In the present study, incidence was higher on the right-side which was similar with the findings of Desai S and Sreepadma S reported in Karnataka population (9). Incomplete ossification was observed in 6% of skulls whereas complete ossification was observed only in 2% of skulls. In the present study, the incidence of incomplete ossification of the caroticoclinoid ligament was observed to be higher than the complete type which was similar with the results of the study in Turkish and Korean populations. Erturk M et al., reported the complete type, contact type and incomplete type in 4.09%, 4.68%, and 14.91%, respectively in Turkish specimens and in a Korean study, the incidence of complete caroticoclinoid canal was reported in 4.1% and incomplete in 11.6% of skulls (14),(24). The incomplete type is more dangerous than the complete type because the bony spurs may impinge on internal carotid artery during pulsations of the internal carotid artery or in case of aneurysms of internal carotid artery which may lead to severe bleeding (11).

The ossified caroticoclinoid ligament can cause compression or stretching of internal carotid artery which may lead to headache and other neurological symptoms due to lack of blood supply to brain (21),(22),(28). The treatment option for the internal carotid artery decompression in this region is the anterior clinoidectomy. The oculomotor nerve, trochlear nerve, abducent nerve, and ophthalmic division of trigeminal nerve pass within a dural fold just infero-lateral to the ACP in the lateral wall of the cavernous sinus. Any of these structures can be damaged during anterior clinoidectomy (21),(22),(28),(29). Care must be taken to avoid injury to the internal carotid artery and the nerves. Radiological investigations such as computed tomography must be performed before planning surgery to avoid intraoperative and postoperative complications related to this region.

Limitation(s)

The present study was limited to only the incidence of ossification of the caroticoclinoid ligament in dry human adult skulls. Further studies on the diameter of the caroticoclinoid foramen, thickness of the ACP and the distance between the ACP and MCP on a large sample can be carried out.

Conclusion

The incidence of ossification of the caroticoclinoid ligament in Telangana population was 8%. Abnormal ossifications in the interclinoid regions especially caroticoclinoid ligament ossification are important for neurosurgeons while performing anterior clinoidectomies or skull base surgeries. Even incomplete ossifications may impinge on the internal carotid artery and lead to profuse bleeding. Ossification of caroticoclinoid ligament must be confirmed by radiological investigations to avoid complications during neurosurgeries of this region.

References

1.
Standring S. Gray’s Anatomy, The Anatomical Basis of Clinical Practice. Intracranial Region. 40th edition, Churchill Livingstone Elsevier, London. 2008;610:424-26.
2.
Lang J. Structure and postnatal organization of heretofore uninvestigated and infrequent ossifications of the sella turcica region. Acta Anat (Basel). 1977;99(2):121-39. https://doi.org/10.1159/000144840. [crossref][PubMed]
3.
Das S, Suri R, Kapur V. Ossification of caroticoclinoid ligament and its clinical importance in skull based surgery. Sao Paulo Med J. 2007;125(6):351-53. [crossref][PubMed]
4.
Binita JP, Praveen RS. Incidence, anatomy and clinical significance of carotico- clinoid foramen and interclinoid osseous bridge in human skulls in Gujarat Region. Int J Anat Radiol Surg. 2018;7(2):AO33-AO37.
5.
Drake CG, Vanderlinden RG, Amacher AL. Carotid-ophthalmic aneurysms. J Neurosurg. 1968;29:24-31. [crossref][PubMed]
6.
Dolene VV. A combined epi and subdural direct approach to carotidophthalmic artery aneurysms. J Neurosurg. 1985;5:667-72. [crossref][PubMed]
7.
Ritesh JB, Minaxi B, Chandrakant M, Ketan BC. Prevalence and dimensions of complete sella turcica bridges and its clinical significance. Indian J Surg. 2015;77(2):S299-S301. Doi: 10.1007/s12262-012-0800-5. [crossref][PubMed]
8.
Magadum A. A study of caroticoclinoid foramen in the south Indian skulls: Incidence. Morphometry and its clinical correlations. Biomirror. 2012;3(05):01-03.
9.
Desai SD, Sreepadma S. Study of carotico clinoid foramen in dry adult human skulls of North Inferior Karnataka. NJBMS. 2010;1(2):60-64.
10.
Keyes JEL. Observations on four thousand optic foramina in human skulls of known origin. Archiv Opthalmol. 1935;13:538-68. [crossref]
11.
Singh R. Caroticoclinoid foramen and associated clinical significance: Comprehensive review. Cureus. 2021;13(1):e12828. https://doi.org/10.7759/ cureus.12828.
12.
Hochstetter F. About the interclinoid taenia, the commissura alicochlearis and the supracochlear cartilage of the human primordial cranium. Gegenbaurs Morph Jahrb. 1940;84:220-43.
13.
Kier EL. Embryology of the normal optic canal and its anomalies. An anatomic and roentgenographic study. Invest Radiol. 1966;1:346-62. [crossref][PubMed]
14.
Erturk M, Kayalioglu G, Govsa F. Anatomy of the clinoidal region with special emphasis on the caroticoclinoid foramen and interclinoid osseous bridge in a recent Turkish population. Neurosurg Rev. 2004;27:22-26. https://link.springer. com/article/10.1007%2Fs10143-003-0265-x. [crossref][PubMed]
15.
Yogesh Y, Nayeemuddin SM, Chakradhar V, Preeti G. Ossification of caroticoclinoid ligament and its clinical importance. IJBR. 2014;05:294-95. [crossref]
16.
Inal M, Muluk NB, Burulday V, Akgül MH, Ozveren MF, Çelebi UO, et al. Investigation of the calcification at the petroclival region through multi-slice computed tomography of the skull base. J Cranio-Maxillofac Surg. 2016;44(4):347-52. https://doi.org/10.1016/j.jcms.2016.01.018. [crossref][PubMed]
17.
Lehmberg J, Krieg SM, Meyer B. Anterior clinoidectomy. Acta Neurochir. 2014;156(2):415-19. https://doi.org/10.1007/s00701-013-1960-1. [crossref][PubMed]
18.
Ota N, Tanikawa R, Miyazaki T, Miyata S, Oda J, Noda K, et al. Surgical microanatomy of the anterior clinoid process for paraclinoid aneurysm surgery and efficient modification of extradural anterior clinoidectomy. World Neurosurg. 2015;83(4):635-43. https://doi.org/ 10.1016/j.wneu.2014.12.014. [crossref][PubMed]
19.
Mikami T, Minamida Y, Koyanagi I, Baba T, Houkin K. Anatomical variations in pneumatization of the anterior clinoid process. J Neurosurg. 2007;106(1):170- 74. Doi: 10.3171/jns.2007.106.1.170. [crossref][PubMed]
20.
Suprasanna K, Kumar A. Surgically relevant bony anatomical variations in paraclinoid aneurysms-three-dimensional multi-detector row computed tomography-based study. J Neurosci Rural Pract. 2017;8(3):330-34. Doi: 10.4103/jnrp.jnrp_416_16. [crossref][PubMed]
21.
Archana R, Anita R, Chopra J, Manik P, Diwan R. Incidence of osseous interclinoid bars in Indian population. Surg Radiol Anat. 2010;32:383-87. Doi: 10.1007%2Fs00276-009-0582-z. [crossref][PubMed]
22.
Kolagi S, Herur A, Patil G, Rairam GB. Complete sella turcica bridges prevalence and dimensions. J Anat Soc India. 2011;60:22-25. Doi: 10.1016/S0003- 2778(11)80005-5. [crossref]
23.
Azeredo RA, Liberti EA, Watanabe IS. Anatomical variations of the clinoid process of the human sphenoid bone. Arq Cent Estud Curso Odontol Univ Fed Minas Gerais. 1988;25-26:09-11.
24.
Lee HY, Chung IH, Choi BY. Anterior clinoid process and optic strut in Koreans. Yonsei Med J. 1997;38:151-54. [crossref]
25.
Bansode SA, Devadas P, Vinila BS. Study of incidence of the carotico-clinoid foramen in the south Indian dry adult skulls: A cross-sectional study. Int J Anat Res. 2017;5(3.1):4051-55. [crossref]
26.
Priya A, Narayan RK, Ghosh SK, Kumar P. Morphometry and morphological analysis of carotico-clinoid foramen: An anatomical study with clinical implications. Folia Morphol. 2021;82(1):108-18. Doi: 10.5603/FM.a2021.0128. [crossref][PubMed]
27.
Vibhash KV, Susmita S, Prachi SA, Neeru K, Suresh KR. Morphometry of sella turcica, anterior clinoid process and carotico-clinoid foramen among north Indian population: A cross-sectional study. J Clin Diag Res. 2022;16(10):AC06-AC10. Doi: 10.7860/JCDR/2022/58224.16889. [crossref]
28.
Ozdog? mus¸ O, Saka E, Tulay C, Gürdal E, Uzün I, Cavdar S. The anatomy of the carotico-clinoid foramen and its relation with the internal carotid artery. Surg Radiol Anat. 2003;25(3-4):241-46. [crossref][PubMed]
29.
Aggrawal B, Gupta M, Kumar H. Ossified caroticoclinoid ligament of sphenoid bone. Bombay Hosp J. 2011;53(4):743-46.

DOI and Others

DOI: 10.7860/JCDR/2023/63911.17997

Date of Submission: Mar 06, 2023
Date of Peer Review: Apr 21, 2023
Date of Acceptance: May 22, 2023
Date of Publishing: Jun 01, 2023

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? No
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. No

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Mar 11, 2023
• Manual Googling: Apr 19, 2023
• iThenticate Software: May 16, 2023 (17%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com