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The lesser wing of the sphenoid is a clinically important structure, particularly with regard to its anatomical relationship with neurovascular structures including the optic nerve, ophthalmic artery, and internal carotid artery. Anterior clinoidectomy, a neurosurgical procedure utilized to access paraclinoid aneurysms and neoplasms, is often complicated by the presence of anatomical variants including the carotico-clinoid foramen and the accessory optic canal.A rare case report is presented documenting the simultaneous occurrence of bilateral carotico-clinoid foramina and a unilateral accessory optic canal.The presence of an accessory optic canal may be misconstrued as a carotico-clinoid foramen or pneumatization of the anterior clinoid process, lesser sphenoidal wing, or optic strut. The case report documents two clinically important variant structures occurring ipsilaterally, each with the potential to masquerade as the other radiographically and present complications to both neurosurgeons and radiologists. Knowledge of the unique combination of anatomical variants presented in this report may prevent adverse surgical events during anterior clinoidectomy procedures including hemorrhage of the ophthalmic artery or internal carotid artery and subsequent vision loss or death.

Carotico-clinoid foramina and a double optic canal: A case report with neurosurgical implications