Endoscopic transnasal surgery of clival lesions: our experience
The clivus is a region characterized by complex anatomy, with vascular and neural structures that are located in close proximity. Different pathologies can affect this area, and traditional surgical approaches were open approaches. Recently, the endoscopic transnasal technique has been introduced, and currently represents a good alternative for the surgical management of these lesions. This is a preliminary report on patients treated endoscopically for clival lesions by the authors’ Skull Base Team.
Patients and methods
This was a retrospective chart review of patients who underwent an endoscopic exclusive transnasal approach (EEA) or a transoral one (TO) for clival lesions between June 2015 and November 2017 at our Skull Base Referral Center. Patient characteristics and symptoms, preoperative neuroradiological evaluation, surgical approach, complications, and postoperative results were evaluated.
Nine patients (6 females and 3 males; age range 6–82 years, mean 50.8 years) underwent EEA or TO. From histological analysis, we found chordomas (6/9 subjects), chondrosarcoma (1/9), craniopharyngioma (1/9), and eosinophilic granuloma (1/9). Three patients had previously been operated for a parasellar chondrosarcoma (1/9), a pituitary macroadenoma (1/9), or a chondroid chordoma (1/9). The lesions were totally (2/9) or sub-totally (5/9) resected, debulked (1/9), or analyzed with a biopsy (1/9). Reconstruction was accomplished with a multilayer technique (7/9), or with a gasket–seal (1/9), using a mucoperichondrial graft, a single/double nasoseptal flap, a middle turbinate flap, a fascia lata, or a synthetic fascia. One patient (11.1%) was re-operated on due to cerebrospinal leakage, without further complications. Two patients (22.2%) were re-operated on due to chordoma regrowth. Adjuvant chemotherapy was administered to 1/9 patient with progressive healing. All of the other patients underwent proton-beam radiotherapy with no documented tumor growth (median follow-up: 20 months; range 5.1–29.9 months).
Clival lesions represent a heterogeneous group of lesions located in a very complex and difficult area. EEA and TO approaches are safe and mini-invasive, with lower morbidity and with postoperative complications when compared to the traditional open approaches, according to the extent and type of pathology.
KeywordsClivus Chordoma Craniopharyngioma Chondrosarcoma Eosinophilic granuloma Transnasal endoscopy
They have no funding to disclose.
Compliance with ethical standards
Conflict of interest
The authors have no conflict of interest.
Research involving animal and human participants
This research involved human participants, who all signed an informed consent before any further treatment.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 8.Frank G, Pasquini E, Doglietto F, Mazzatenta D, Sciarretta V, Farneti G et al (2006) The endoscopic extended transsphenoidal approach for craniopharyngiomas. Neurosurgery 59(1 Suppl 1):ONS75-83 (discussion ONS75-83)Google Scholar
- 15.Lund VJ, Stammberger H, Nicolai P, Castelnuovo P et al (2010) European position paper on endoscopic management of tumours of the nose, paranasal sinuses and skull base. Rhinology Suppl 22:1–143Google Scholar
- 26.Ellison DW, Perry A, Rosenblum M, Asa S, Reid R, Louis DN (2008) Tumors: non-neuroepithelial tumours and secondary effects. Edward Arnold, London, pp 2002–2182Google Scholar
- 31.Brisman JL, Feldstein NA, Tarbell NJ, Cohen D, Cargan AL, Haddad J Jr, Bruce JN (1997) Eosinophilic granuloma of the clivus: case report, follow-up of two previously reported cases, and review of the literature on cranial base eosinophilic granuloma. Neurosurgery Jul 41(1):273–278 (discussion 278–279)CrossRefGoogle Scholar