The Medial Opticocarotid Recess: An Anatomic Study of an Endoscopic "Key Landmark" for the Ventral Cranial Base

BACKGROUND: The medial opticocarotid recess (MOCR) has become an important landmark for endoscopic approaches to the cranial base. OBJECTIVE: To examine the anatomy of the MOCR and outline its role as a "key landmark" for approaches to the sellar and suprasellar regions. METHODS: Ten silicone-injected cadaveric specimens and 96 dry crania were examined. Dissections were done endoscopically and microscopically. RESULTS: The lateral tubercular recess is an osseous depression located at the lateral edge of the tuberculum when viewed from the sphenoid sinus. Intracranially, it corresponds to the lateral tubercular crest (LTC), a ridge situated at the superomedial aspect of the carotid sulcus. The MOCR is a teardrop-shaped osseous indentation formed at the medial junction of the paraclinoid carotid canal and the optic canal. Dorsally, it is represented by a teardrop-shaped area with vertices at the inferior aspect of the LTC, the medial aspect of the junction of the superior and posterior surfaces of the optic strut, and the superolateral aspect of the tuberculum. The middle clinoid process is situated inferior to the LTC. The distal osseous arch of the carotid sulcus connects the lateral opticocarotid recess to the lateral tubercular recess and is a landmark for the paraclinoid internal carotid artery. Only 44% of the specimens had middle clinoid processes. CONCLUSION: The MOCR and middle clinoid process are distinct structures. Because of its location at the confluence of the optic canal, the carotid canal, the sella, and the anterior cranial base, the MOCR is a key landmark for endoscopic approaches.