Endoscopic Endonasal Transclival Approach with the Posterior Clinoidectomy

Objective To describe the radiological and surgical anatomy, and technical nuances for endoscopic endonasal transclival approach with posterior clinoidectomy and to report our experience in 21 patients with this approach.

Methods The surgical anatomy of this approach was studied in anatomical specimens. The radiological anatomy was studied with CT, MR images, and the 3D model which was constructed from CT and MR images. Surgical technique and drilling technique are described with the illustrative cases.

Results The 21 patients were operated, 10 cases were craniopharyngioma, 3 cases were meningioma, 3 cases were chordoma, 2 cases were chondrosarcoma, and 1 case was solitary fibrous tumor, schwannoma and nonfunctional pituitary adenoma. All the cases were operated successfully using this procedure with resection performed in all patients without neurovascular injury related to this procedure and facilitated a greater resection of the tumors.

Three patients experienced transient post-op sixth nerve paresis, three patients had cerebrospinal fluid leakage and needed repair, and another had panhypopituitarism.

Conclusion Endoscopic endonasal transclival approach with posterior clinoidectomy increases the working space and the maneuverability of the instruments to remove the tumor extended behind the posterior clinoid and dorsum sellae.

Publikationsverlauf

Publikationsdatum:
02. Februar 2018 (online)