Endoscopic Transsphenoidal, Transclival Resection of an Enterogenous Cyst Located Ventral to the Brainstem: Case Report

Abstract

We discuss the endoscopic transsphenoidal approach used for the resection of an enterogenous cyst in the posterior fossa anterior to the brainstem. The transsphenoidal approach provides direct access to lesions in this location using a minimally invasive technique while avoiding excessive brain retraction or injury to cranial nerves. In addition, we provide an updated review of the literature for enterogenous cysts located within the posterior fossa.

Focal Transnasal Approach to the Upper, Middle, and Lower Clivus

“…[1][2][3][4][5][6] The endoscopic transnasal transclival approach to the posterior fossa overcomes some of these disadvantages. [7][8][9][10][11][12][13][14] It provides a direct route to midline structures and allows them to be viewed without retraction of the brain. The approach offers a panoramic view of the anterior surface of the brainstem by drilling the whole or a part of the clivus.…”

Endoscopic Endonasal Transclival Approach for Resection of a Pontine Glioma: Surgical Planning, Surgical Anatomy, and Technique

“…Although fiber tract anatomy may help in defining the so-called safe entry zones to the ventral brainstem, the reality is that relevant tracts may be displaced in a way that are mistakenly included in the selected surgical corridors. 3,24 Abla et al 2 reported up to 36% rate of permanent new deficits when following the 2-point methods for brainstem cavernous malformation resection. As previously reported for brainstem lesions, DTI-based fiber tracking serves as an important tool to preoperatively assess the integrity and status of the white matter tracts.…”

“…For lesions that are located predominantly ventrally, the endoscopic endonasal approach (EEA) has been proposed as a potential alternative. [2][3][4] A recent anatomic study of the endoscopic endonasal perspective on intra-axial brainstem surgery has been reported, but no clinical examples were available for presentation, and no application of fiber tractography techniques was provided. As the authors pointed out, the anterior perspective on the anatomy, as well as the understanding of the clinical feasibility and limitations of the EEA in this context, is still lacking.…”

Anatomical Study of Posterior Clinoid Process (PCP) and Its Clinical Meanings

“…[6][7][8] Extended transphenoid surgery has also been widely performed in well-pneumatized sphenoids. Tumors in the sellar region can also be removed using the transphenoid method.…”