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J Neurol Surg B Skull Base. 2013 Aug;74(4):217-24. doi: 10.1055/s-0033-1342915. Epub 2013 Apr 12.

Critical appraisal of extent of resection of clival lesions using the expanded endoscopic endonasal approach.

Author information

1
Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
2
Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
3
Department of Radiology, David Geffen School of Medicine, University of California, Los Angeles, California, USA.

Abstract

Objectives To present a critical evaluation of our experience using an expanded endoscopic endonasal approach (EEEA) to clival lesions and evaluate, based on the location of residual tumor, what the anatomic limitations to the approach are. Design A retrospective review of all endoscopic endonasal operations performed at our institution identified 19 patients with lesions involving the clivus. Extent of resection was determined by preoperative and postoperative tumor volumes. Results Three patients underwent planned subtotal resections. Of the remaining patients, gross total resection was achieved in 8/16 (50%), > 95% in 5/16 (31%), and < 95% in 3/16 (19%). Residual tumor occurred, most commonly with extension posterior and lateral to the internal carotid artery, with inferior, lateral invasion of the occipital condyle and with deep inferior extension to the midportion of the dens. Conclusions The EEEA represents a safe and effective technique for the resection of clival lesions. Despite excellent overall visualization of this region we found that adequate exposure of the most lateral and inferior portions of large tumors is often difficult. Knowledge of these limitations allows us to determine which tumors are best suited for an EEEA and which may be more appropriate for an open skull base or combined technique.

KEYWORDS:

clival lesions; endoscopy; minimally invasive; transnasal transsphenoidal

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