Accessory optic canals and a caroticoclinoid foramen in an infant: considerations for anterior clinoidectomy in the pediatric population.

Introduction/Background: Anterior clinoidectomy is a routine neurosurgical procedure for the management of paraclinoid aneurysms and tumors in adults; however, it has been performed less extensively in children. The anterior clinoid process of the sphenoid bone is closely related to vital neurovascular structures including the optic nerve, internal carotid artery, and the ophthalmic artery. Therefore, sphenoidal variants, such as the accessory optic canal and caroticoclinoid foramen, pose serious complications in anterior clinoidectomy including potential blindness and death. Case presentation: This report presents a novel case of concomitant bilateral accessory optic canals and a right-sided caroticoclinoid foramen found within an infantile sphenoid of a 12-month-old black male. The case report documents two co-occurring, clinically relevant variants known to complicate anterior clinoidectomy in an individual from a population that has been underrepresented in the literature. Conclusions: Caroticoclinoid foramina and accessory optic canals can be mistaken for each other on preoperative imaging, and accessory optic canals can additionally be mistaken for pneumatization of the anterior clinoid process, lesser sphenoidal wing, or optic strut. A high index of suspicion for these anatomic variants on preoperative imaging could enable the prevention of adverse outcomes, including hemorrhaging of the internal carotid artery and/or ophthalmic artery and subsequent blindness or death.