Anatomical restrictions in the transsphenoidal, transclival approach to the upper clival region: A cadaveric, anatomic study

Aktaş, Ulaş; Yılmazlar, Selçuk; Uğraş, Nesrin

doi:10.1016/j.jcms.2012.11.011

Cited by 20 publications

(20 citation statements)

References 37 publications

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“…Utilizing consistent and easily identifiable landmarks is critical to endoscopic endonasal surgery . Positional awareness can reduce the risk of intraoperative complications and postoperative morbidity that can occur when operating around the critical and often delicate structures of the ITF.…”

Section: Discussionmentioning

confidence: 99%

“…Traditional open ITF approaches carry the risk of substantial morbidity and mortality, with limitations frequently imposed by critical anatomic structures. The advent of endoscopic technology and endoscopic endonasal techniques allows for an alternative approach to the ITF and skull base that provides potentially equivalent exposure with decreased morbidity and mortality …”

Section: Introductionmentioning

confidence: 99%

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Analysis of the petrous portion of the internal carotid artery: Landmarks for an endoscopic endonasal approach

et al. 2014

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Analysis of the petrous portion of the internal carotid artery: Landmarks for an endoscopic endonasal approach

et al. 2014

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“…To our knowledge, there is no evidence in the current literature on the incidence of this variation in the population of our country. Thus, this report will be useful to increase the knowledge about this region that has considerable clinical interest 2,4 (clival tumours had very high mortality and morbidity rates) 5 , and finally to help promoting future studies in this area. Figure. Internal view of the skull base with the presence of clival canal (a) being crossed by a histological needle (b).…”

Section: O Canal Clivalmentioning

confidence: 95%

The clival canal

Campos

Jotz

Goulart

et al. 2015

Arq. Neuro-Psiquiatr.

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OPINION The clival canal O canal clivalIn a skull of an approximately 35-year-old belonging to the didactical collection of the University of Santa Cruz do Sul, Brazil, it was noted the clival canal of the occipital portion of the clivus (Figure). According to recent descriptions 1 , a clival canal was identified in 1.6% of skulls and there is limited information on bony canals in the occipital part of the clivus. Moreover, the presence of clival canal hasn't been reported in classic anatomical textbooks.The finding of a clival canal might interfere with neurosurgical operations in the clival region and possibly provoke symptoms of the basilar artery, as well as of the basilar plexus 2 . In addition, clinicians and radiologists should take into account this variability when managing cerebral venous disorders or interpreting imaging studies of the skull base 3 . To our knowledge, there is no evidence in the current literature on the incidence of this variation in the population of our country. Thus, this report will be useful to increase the knowledge about this region that has considerable clinical interest 2,4 (clival tumours had very high mortality and morbidity rates) 5 , and finally to help promoting future studies in this area. Figure.Internal view of the skull base with the presence of clival canal (a) being crossed by a histological needle (b). The shape is like a channel 9.1 mm in length and 1.9 mm in diameter. The canal was situated 3.5 mm in front the anterior border of the foramen magnum. In our observations we didn't find any indication of associated pathology this anatomical variation.

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“…The narrow operative field required for this approach limits effective intraoperative management of vascular injury. [16] Intracranial tumors complicate the anatomy by eroding through local structures, including the carotid artery, creating potential for iatrogenic injury. Traditionally, internal carotid artery (ICA) injury during surgery is treated by artery ligation; however, this method can lead to numerous complications.…”

Section: Introductionmentioning

confidence: 99%

Combined use of covered stent and flow diversion to seal iatrogenic carotid injury with vessel preservation during transsphenoidal endoscopic resection of clival tumor

Shakir¹,

Garson²,

Sorkin³

et al. 2014

Surg Neurol Int

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Background:Transsphenoidal tumor resection can lead to internal carotid artery (ICA) injury. Vascular disruption is often treated with emergent vessel deconstruction, incurring complications in a subset of patients with poor collateral circulation and resulting in minor and major ischemic strokes.Methods:We attempted a novel approach combining a covered stent graft (Jostent) and two flow diverter stents [Pipeline embolization devices (PEDs)] to treat active extravasation from a disrupted right ICA that was the result of a transsphenoidal surgery complication. This disruption occurred during clival tumor surgery and required immediate sphenoidal sinus packing. Emergent angiography revealed continued petrous carotid artery extravasation, warranting emergent vessel repair or deconstruction for treatment. To preserve the vessel, we utilized a covered Jostent. Due to tortuosity and lack of optimal wall apposition, there was reduced, yet persistent extravasation from an endoleak after Jostent deployment that failed to resolve despite multiple angioplasties. Therefore, we used PEDs to divert the flow.Results:Flow diversion relieved the extravasation. The patient remained neurologically intact post-procedure.Conclusions:This case demonstrates successful combined use of a covered stent and flow diverters to treat acute vascular injury resulting from transsphenoidal surgery. However, concerns remain, including the requirement of dual antiplatelet agents increasing postoperative bleeding risks, stent-related thromboembolic events, and delayed in-stent restenosis rates.

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Anatomical restrictions in the transsphenoidal, transclival approach to the upper clival region: A cadaveric, anatomic study

Cited by 20 publications

References 37 publications

Analysis of the petrous portion of the internal carotid artery: Landmarks for an endoscopic endonasal approach

Analysis of the petrous portion of the internal carotid artery: Landmarks for an endoscopic endonasal approach

The clival canal

Combined use of covered stent and flow diversion to seal iatrogenic carotid injury with vessel preservation during transsphenoidal endoscopic resection of clival tumor

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