A Direct Corridor to the Clivus: The Expanded Endonasal Approach. A Review of the Transclival Module in Endoscopic Skull Base Surgery

Introduction: Traditionally, surgical approaches to the clivus have been limited by the presence of critical neurovascular structures within the surgical field. With the development of the endoscopic endonasal approach to the clivus, we have used a corridor that places the majority of these neurovascular structures on the perimeter of the surgical field.

Methods: We reviewed the pathology and complications associated with the transclival approach to the skull base.

Results: From 1998 to 2007, over 700 patients have undergone the expanded endonasal approach to skull base pathology. In 87 patients we utilized the transclival module for malignant (42.5%), benign (34.5%), miscellaneous (19.5%), trauma (2.2%), and inflammatory (1.1%) pathology. The most common lesions have been chordomas/chondrosarcomas (20) and meningiomas (11). We had a major complication rate of 9.2% with 3.4% having a poor outcome: there were 2 deaths (1 neuro-related) and 1 permanent neurologic deficit. We had a minor complication rate of 12.6%.

Conclusions: The expanded endonasal approach affords the neurosurgeon direct access to the clivus. Through a minimally invasive approach, the transclival module can be used safely to access a variety of pathologies located at the cranial base.