Endoscopic Endonasal Approaches to the Clival Region

Ravnik, Janez; Hribernik, Borut; Lanišnik, Boštjan

doi:10.5644/ama2006-124.306

Cited by 3 publications

(2 citation statements)

References 33 publications

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“…Ravnik et al showed a postoperative CSF leak rate of 16% following clival approach to endoscopic tumor removal and a 37.5% postoperative leak rate when the dura was opened intraoperatively. 1 Data on CSF leak repair following clival fracture and for previously unreported cases of clival CVF are sparse.…”

Section: Discussionmentioning

confidence: 99%

“…Reconstruction of clival skull base defects offer a unique challenge with respect to tissue mobility due to prevertebral musculature, unique anatomic geometry, and often high‐flow CSF leakage. Ravnik et al showed a postoperative CSF leak rate of 16% following clival approach to endoscopic tumor removal and a 37.5% postoperative leak rate when the dura was opened intraoperatively 1 . Data on CSF leak repair following clival fracture and for previously unreported cases of clival CVF are sparse.…”

Section: Discussionmentioning

confidence: 99%

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CSF‐Venous Fistula of the Clival Skull Base: A Unique Case Study and Literature Review

Simmons,

Nadeem,

Maya

et al. 2023

The Laryngoscope

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An adolescent male presented with orthostatic headaches following head trauma. MRI showed cerebellar tonsil displacement and a bony defect in the clival skull base. Digital subtraction myelography (DSM) confirmed a cerebrospinal fluid‐venous fistula (CVF). This was repaired endoscopically. CVFs cause uncontrolled flow of CSF into the venous system resulting in symptoms of intracranial hypotension. They're often difficult to identify on initial imaging. This is the first reported CVF originating in the central skull base, and the first treated via endoscopic trans‐nasal approach. CVFs may elude initial imaging, making DSM crucial for unexplained spontaneous intracranial hypotension. Laryngoscope, 2023

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

CSF‐Venous Fistula of the Clival Skull Base: A Unique Case Study and Literature Review

Simmons,

Nadeem,

Maya

et al. 2023

The Laryngoscope

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Pons herniation after skull base chondrosarcoma surgery: A rare complication after transclival endoscopic endonasal approach

Almeida,

da Silva,

de Almeida

et al. 2024

Surgical Neurology International

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Background: Intracranial chondrosarcomas are malignant tumors that most commonly affect the clivus region. For tumors in this location, the extended endoscopic endonasal approach could offer an alternative route. We present a case of pons herniation after this technique. Case Description: A 55-year-old female presented with a 6-month history of difficulty walking. The neurological evaluation showed asymmetric tetra paresis and involvement of the IX cranial nerve on the right side. Imaging exams showed a lesion at the upper clivus, with a possible diagnosis of chondrosarcoma. An extended transclival approach with partial resection and a multilayer closure were performed. The patient had a slight immediate improvement in muscle strength, and she was discharged home 5 days after surgery. Four weeks later, she evolved with worsening strength on the left side. A new image examination revealed an atypical protrusion of the pontine tissue through the bone defect at the opening of the clivus; a surgical revision was proposed, but the patient chose conservative management. Conclusion: Pontine herniation is a rare complication with no defined cause. The use of a rigid material for closure could reduce the chances of this complication, but futher studies are necessary to reinforce that hypothesis.

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Clival Metastases: Single-Center Retrospective Case Series and Literature Review

Carretta,

Sollini,

Guaraldi

et al. 2024

JCM

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Background/Objectives: Clivus metastases from distant neoplasms are uncommon occurrences both in clinical practice and the neurosurgical literature. Surgical management is debated, particularly about the role of surgery and the preferable approach. The aim of this study was to report our surgical experience and review the concerning literature. Methods: Our institutional registry was retrospectively reviewed, and patients who underwent surgical treatment for clival metastasis from 1998 to 2023 were included. A PRISMA systematic review of the literature was performed. Results: Four patients were enrolled, and all of them underwent an endoscopic endonasal approach (EEA). Three presented with cranial nerve (CN) VI palsy. The aim of surgery was biopsy in all cases. No complications were reported. Mean overall survival (OS) was 6 ± 1 months. The systematic review retrieved 27 papers reporting 39 patients who underwent the surgical treatment of clivus metastases. Most of them (79.5%) presented with CN palsies, and EEA was the preferred approach in 92.3% of the cases, to perform a biopsy in most patients (59%). Two hemorrhagic complications (5.1%) were reported, and the mean OS was 9.4 ± 5.6 months. Conclusions: Clival metastases are uncommonly observed, in most cases, during advanced stages of oncological disease. The aim of surgery should be the confirmation of diagnosis and symptomatic relief, balancing the risk–benefit ratio in a multidisciplinary context. EEA is the approach of choice, and it should be carried out in experienced tertiary skull base centers.

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Endoscopic Endonasal Approaches to the Clival Region

Cited by 3 publications

References 33 publications

CSF‐Venous Fistula of the Clival Skull Base: A Unique Case Study and Literature Review

CSF‐Venous Fistula of the Clival Skull Base: A Unique Case Study and Literature Review

Pons herniation after skull base chondrosarcoma surgery: A rare complication after transclival endoscopic endonasal approach

Clival Metastases: Single-Center Retrospective Case Series and Literature Review

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