Endoscopic endonasal minimal access approach to the clivus: Case series and technical nuances

Justin F. Fraser, Gurston G. Nyquist, Nicholas Moore, Vijay K. Anand, Theodore H. Schwartz

Research output: Contribution to journalArticlepeer-review

78 Scopus citations

Abstract

BACKGROUND: The endoscopic endonasal transclival approach is a novel minimal-access method of managing clival pathology. Limited cases have been published. OBJECTIVE: To summarize our clinical experience with this approach and discuss technical nuances. METHODS: We retrospectively reviewed a prospective database of 250 endoscopic, endonasal skull base surgeries. Patients in whom a transclival approach was performed were identified. Extent of resection, complications, and clinical outcome were analyzed. RESULTS: Seventeen patients underwent 21 procedures. Pathology included chordoma, meningioma, hemangiopericytoma, enterogenous cyst, epidermoid, and metastasis. Lumbar drain was placed intraoperatively in 9 cases and maintained for approximately 2 days postoperatively. Mean operative time was 252.8 minutes. Intraoperative cerebrospinal fluid (CSF) leak occurred in 10 cases. Greater than 95% resection was achieved in 11 of 12 cases (92%) in which it was the surgical goal. The risk of postoperative CSF leak was 4.8% for all procedures, 9.1% for procedures with large skull base defect, and 0% if a gasket-seal closure was achieved. A nasoseptal flap was used in 2 patients. There was one perioperative infarct, one case of deep vein thrombosis, and one postoperative pulmonary embolus. Mean follow-up was 8.5 months. All but one patient with preoperative cranial nerve deficits improved at last follow-up. All patients were free of disease progression at last follow-up. CONCLUSIONS: The endonasal endoscopic transclival approach provides a minimal-access approach to the ventral midline posterior fossa skull base. The risk of CSF leak is low if appropriate closure techniques are applied.

Original languageEnglish
Pages (from-to)ons150-ons158
JournalNeurosurgery
Volume67
Issue numberSUPPL. 1
DOIs
StatePublished - Dec 2010

Keywords

  • Clivus
  • CSF leak
  • Endonasal
  • Endoscopy
  • Minimally invasive
  • Skull base
  • Transnasal
  • WORDS: Chordoma

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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