Transoral stereotactic technique for clival biopsy

Objective: To report a transoral freehand technique using continuous image guidance to biopsy a clival lesion. Methods: The patient was placed in aMayfield head rest. Patient data were registered using preacquired magnetic resonance and computed tomography images, and then, under continuous image guidance, a bone biopsy instrument was advanced freehand through a transoral route into the clival lesion. Results: Bone biopsy instrumentation was successfully placed into the clival lesion. Biopsy forceps were placed through the working channel of the biopsy instrumentation and specimen was successfully retrieved from the clival mass. The patient tolerated the procedure well and the only complaint was dysphagia, which resolved in several days postoperatively. Conclusion: The transoral freehand technique with stereotactic navigation was found to be a simple, safe, fast, and effective way to biopsy a clival lesion.