Endoscopic Endonasal Transclival Approach and Retrosigmoid Approach to the Clival and Petroclival Regions

Abstract

Different endoscopic surgical corridors can be delineated with the endonasal transclival and retrosigmoid approaches to the clival/petroclival area. Some relevant neurovascular structures may limit the extension of the approach and the view via both routes. The combination of the 2 approaches may improve the visualization in this challenging area.

Anatomic comparison of anterior petrosectomy versus the expanded endoscopic endonasal approach: interest in petroclival tumors surgery

“…In 2009, De Notaris et al explored the anatomy of the petroclival region in an endoscopic study comparing the trans-sphenoidal and retro-sigmoid approaches [13]. They brought a precise description of the limits of each routes from a strictly endoscopic point of view.…”

Endoscopic endonasal removal of laterally extended clival chordoma using side-viewing scopes

“…With the recent technical advancements in endoscopic surgery, an endoscopic endonasal approach is becoming indicated for this lesion [7,9,11,14,23,24]. The petrous apex behind the carotid artery, to which the clival chordomas frequently extends, is, however, often obscured, constituting the lateral limit of the approach [3,7,8,11,23,28]. The endoscopic transpterygoid approach is a valid option for accessing such laterally extended tumor compartments [9,13,15].…”

“…There are also some reports about endoscopic removal of the clival chordoma with promising results [7,9,11,14,24]. If the tumor invades laterally, however, visualization and management of the tumor in the retro-carotid space under the straight view endoscope become restricted [3,7,8,11,23,28]. To overcome the limitation, we applied a side-viewing endoscope and added surgical maneuvers with malleable and/or steerable instruments in four patients with clival chordoma.…”

Mucosal-sparing posterior septectomy for endoscopic endonasal approach to the craniocervical junction

“…Previously described endoscopic endonasal transclival and transodontoid approaches have allowed surgeons to overcome many of the morbidities and complications associated with transoral or transcervical approaches [15][16][17][18]. Traditionally both endonasal approaches employ a posterior bony and mucosal septectomy.…”