Skip to main content
SpringerLink
Log in

Stereotactic biopsy approach to the upper clivus through the middle fossa floor that avoids pneumatised cavities and the intradural compartment

  • Case Report - Neurosurgical Techniques
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Biopsies of clival lesions are usually performed, under general anaesthesia, through an anterior endoscopic approach or, alternatively, through a trans-nasal or trans-oral stereotactic approach.

Methods

A 57-year-old man with a symptomatic osteolytical lesion of the clivus, who refused general anaesthesia, underwent a sterotactically guided biopsy of the lesion by an antero-lateral approach through the temporal and sphenoid bones.

Results

Biopsy was successfully performed and the resulting diagnosis was myeloma. The patient was comfortable during and after surgery and there were no complications.

Conclusions

The present stereotactic antero-lateral approach to the biopsy of the upper clivus can be considered an useful adjunct to the current trans-oral and transnasal approaches that often require general anaesthesia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Abrahams JJ (1998) Mandibular sigmoid notch: a window for CT guided biopsies of lesions in the peripharyngeal and skull base regions. Radiology 208:695–699

    Article  CAS  PubMed  Google Scholar 

  2. Bootz F, Keiner S, Schulz T, Scheffler B, Seifert V (2001) Magnetic resonance imaging—guided biopsies of the petrous apex and petroclival region. Otol Neurotol 22:383–388

    Article  CAS  PubMed  Google Scholar 

  3. Esposito MB, Arrington JA, Murtagh FR, Ridley MB, Endicott JN, Silbiger ML (1996) Anterior approach for CT guided biopsy of skull base and parapharyngeal space lesions. J Comput Assist Tomogr 20:739–741

    Article  CAS  PubMed  Google Scholar 

  4. Gagliardi F, Losa M, Boari N, Spina A, Reni M, Terreni MR, Mortini P (2013) Solitary clival plasmocytomas: misleading clinical and radiological features of a rare pathology with a specific biological behaviour. Acta Neurochir (Wein) 155:1849–1856

    Article  Google Scholar 

  5. Hirschl R, Miller B, Ammirati M (2009) Transoral stereotactic technique for clival biopsy. Skull Base 19:287–289

    Article  PubMed  PubMed Central  Google Scholar 

  6. Jung CS, Zimmermann M, Seifert V (2004) Clivus lymphoma. Acta Neurochir (Wein) 146:533–534

    Article  CAS  Google Scholar 

  7. Kelley TF, Stankiewicz JA, Chow JM, Origitano TC (1999) Endoscopic transsphenoidal biopsy of the sphenoid and clival mass. Am J Rhinol 13:17–21

    Article  CAS  PubMed  Google Scholar 

  8. Neelakantan A, Rana AK (2014) Benign and malignant diseases of the clivus. Clin Radiol 69:1295–1303

    Article  CAS  PubMed  Google Scholar 

  9. Patil AA, Chand A (1995) Modifications of transnasal and transoral stereotactic procedures: technical notes. Acta Neurochir (Wein) 134:46–50

    Article  CAS  Google Scholar 

  10. Patil AA, Leibrock L, Kumar P, Arabi B (1991) Stereotactic approach to skull base lesions. Skull Base Surg 1:235–239

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Phadke R, Saha M, Prasad K, Goyal D (2001) Transnasal access for sampling a skull base lesion. AJNR Am J Neuroradiol 22:745–747

    CAS  PubMed  Google Scholar 

  12. Rosenfeld JV, Wallace D, Klug GL, Danks A (1992) Transnasal stereotactic biopsy of a clival tumour: technical note. J Neurosurg 76:878–879

    Article  CAS  PubMed  Google Scholar 

  13. Schulz T, Shneider JP, Bootz F, Keiner S, Sheffler B, Weidenbach H, Dietrich J, Shirmer T, Schmidt F, Kahn T (2001) Transnasal and transphenoidal MRI-guided biopsy of petroclival tumor. J Magn Reson Imaging 13:3–11

    Article  CAS  PubMed  Google Scholar 

  14. Vellutini Ede A, Balsalobre L, Hermann DR, Stamm AC (2014) The endoscopic endonasal approach for extradural and intradural clivus lesions. World Neurosurg 82(6 Suppl):S106–S115

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Neurosurgical Unit, Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Fondazione IRCCS Policlinico S. Matteo, V. le Golgi 19, 27100, Pavia, Italy

    Lorenzo Magrassi & Elena Moretti

  2. Department of Neuropathology, Southmead Hospital, Bristol, BS10 5NB, UK

    Marco Marchionni

  3. Neuroradiology Unit, National Neurological Institute IRCCS Fondazione C. Mondino, Pavia, Italy

    Elisa Rognone

  4. Department of Haematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

    Bonfichi Maurizio

Authors
  1. Lorenzo Magrassi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elena Moretti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marco Marchionni
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elisa Rognone
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bonfichi Maurizio
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lorenzo Magrassi.

Ethics declarations

Conflicts of interest

All authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Patient consent

The patient has consented to the submission of the case report for submission to the journal.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Magrassi, L., Moretti, E., Marchionni, M. et al. Stereotactic biopsy approach to the upper clivus through the middle fossa floor that avoids pneumatised cavities and the intradural compartment. Acta Neurochir 158, 717–720 (2016). https://doi.org/10.1007/s00701-016-2722-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-016-2722-7

Keywords

Search

Navigation