掌握后床突切除技术对于专门从事内窥镜鼻内入路的神经外科医生来说至关重要，因为后床突（PCP）通常涉及软骨样肿瘤切除。已开发出三种用于后床突切除术的主要技术：硬膜内、硬膜外和经海绵体硬膜间。作者在此介绍了一种新颖的技术变体，其中在颈斜韧带横断后将经海绵入路延伸至背床突间隙，并在解剖学解剖和放射学研究的基础上详细阐述了其临床应用。作者回顾了 CT 血管造影图像对 50 名成年人的 PCP 进行 3D 重建，以分析骨化韧带附着物的高度和存在情况。此外，对 20 个经过轻微防腐处理的死后人类头部进行了内窥镜鼻内后床突切除术。依次进行了三种技术，包括硬膜外、经海绵体和扩大经海绵体后床突切除术，并对每种技术的解剖标志和暴露区域进行了研究和比较。通过放射学研究，作者将 PCP 分为以下两种类型中的一种：1) 正常，定义为高度小于或等于 8 毫米，且无骨化韧带附着物；或 2) 复杂，定义为高度大于 8 毫米，有或没有骨化韧带附着。与硬膜外（暴露 PCP 高度 4.7 ± 0.5 mm）和经海绵体内（暴露 PCP 高度 7.3 ± 0.8 mm）后床突切除术相比，扩展经海绵体后床突切除术提供了最大暴露 PCP 高度（9.6 ± 0.4 mm；p < 0.0001）。本报告详细介绍了扩展经海绵窦后床突切除术作为一种新颖的技术变体，用于在内窥镜鼻内手术中实现 PCP 的最大暴露。此外，积极的结果证实了术前颅底成像对于手术计划的重要性。

Mastery of the posterior clinoidectomy technique is of utmost importance for neurosurgeons who specialize in endoscopic endonasal approaches, because the posterior clinoid process (PCP) is commonly involved in chondroid tumor resection. Three main techniques for posterior clinoidectomy have been developed: intradural, extradural, and transcavernous interdural. The authors introduce here a novel technical variant in which the transcavernous approach is extended to the dorsal clinoidal space after transection of the caroticoclinoid ligament, and they elaborate on its clinical application on the basis of anatomical dissections and radiological studies.The authors reviewed CT angiography images and 3D reconstruction of the PCP in 50 adults to analyze the height and presence of ossified ligament attachments. In addition, endoscopic endonasal posterior clinoidectomy was performed in 20 lightly embalmed postmortem human heads. Three techniques, including extradural, transcavernous, and extended transcavernous posterior clinoidectomy, were performed sequentially, and anatomical landmarks and areas exposed with each technique were investigated and compared.Using radiological studies, the authors categorized the PCPs as 1 of 2 types: 1) normal, defined as less than or equal to 8 mm high with no ossified ligament attachments; or 2) complex, defined as greater than 8 mm high with or without an ossified ligament attachment. Compared with extradural (exposed PCP height 4.7 ± 0.5 mm) and transcavernous (exposed PCP height 7.3 ± 0.8 mm) posterior clinoidectomies, the extended transcavernous posterior clinoidectomy provided the maximally exposed PCP height (9.6 ± 0.4 mm; p < 0.0001).This report details the extended transcavernous posterior clinoidectomy as a novel technical variant for achieving maximal exposure of the PCP in endoscopic endonasal surgery. In addition, the positive results establish the importance of preoperative skull base imaging for surgical planning.