Transmaxillary-Transnasal Approach to the Anterior Clivus

Rabadán, Alejandra T.; Conesa, Horacio

doi:10.1097/00006123-199204000-00001

Cited by 14 publications

(18 citation statements)

References 21 publications

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“…Anterior approaches to the cervical vertebral junction and clivus were originally proposed for the treatment of vertebrobasilar aneurysms [22,23] or neoplasms [24]. Anterior access route includes the transseptal-transsphenoidal, transmaxillary, transpalatal and transoral-transpalatal, transmandibular, transmaxillary-transnasal, and the facial translocation approaches [25][26][27][28][29][30][31]. And now the endoscopic approach to the clivus has become a well-established alternative to traditional surgery.…”

Section: Discussionmentioning

confidence: 99%

The anatomic study of clival screw fixation for the craniovertebral region

Wang

et al. 2012

Eur Spine J

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Purpose To study the anatomic parameters related to clival screw and establish reference data concerning the craniovertebral fixation technique. Methods Morphometric measurement of the clivus and the surrounding anatomic structures were obtained on 41 dry bone specimens. Then, 2-D CT reconstruction of the craniovertebral region of 30 patients (19 men and 11 women, ranging in age from 20-64 years with an average age of 38.8 years) were performed to measure the safety range for a 3.5-mm screw placement. Nine entry points were evaluated. Finally, one male fresh cadaver specimen (age 46 years) was dissected to observe the craniovertebral region. Results The clivus faces the basilar artery, the V * XII cranial nerves, the pons, and ventral medulla oblongata at its intracranial surface. The longitudinal diameter of extracranial clivus was 25.87 ± 2.64 mm. The narrowest diameter of the clivus was 12.84 ± 1.08 mm, the distance between the left and right hypoglossal canal was 32.70 ± 2.09 mm at its widest part. The distance between the left and right structures, the maximum value was 49.31 ± 4.16 mm at carotid canal, the minimum value was 16.54 ± 2.04 mm at the occipital condyle. The measurement of clival screws placement simulation via 2-D CT reconstruction images shows the maximum upper insertion angle of three components the optimal entry points, the candidate points, the limit entry points was 130.19°, 125.23°and 85.72°, and the total mean screw length was 7.57, 10.13 and 15.6 mm at the vertical entry angle, respectively. Conclusions Clival screw placement is a viable option for craniovertebral fixation. There is a safe scope for the screw length and angle of the screw placement. And, these parameters obtained in the present study will be helpful for anyone contemplating the use of clival screw fixation.

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Section: Discussionmentioning

confidence: 99%

The anatomic study of clival screw fixation for the craniovertebral region

Wang

et al. 2012

Eur Spine J

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“…When a lateral extension is needed, a transmaxillary route may be used [40][41][42][43]. Endoscopy may maximize the exposure in all directions [44][45][46][47].…”

Section: Discussionmentioning

confidence: 99%

The implications of microsurgical anatomy for surgical approaches to the sellar region

et al. 2009

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The knowledge of the normal anatomy and variations regarding the management of tumors of the sellar region is paramount to perform safe surgical procedures. The sellar region is located in the center of the middle cranial fossa; it contains complex anatomical structures, and is the site of various pathological processes: tumor, vascular, developmental, and neuroendocrine. We review the microsurgical anatomy (microscopic and endoscopic) of this region and discuss the surgical nuances regarding this topic, based on anatomical concepts.

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“…A detailed analysis of the advantages and disadvantages of each approach proposed for resection of skull base chordomas is beyond the scope of this article, and excellent reports have already been published on this topic. 1,11,17,23,26,27,33,36,37,45,47,51,55,57,58,76,[86][87][88][89]94 Careful study of the preoperative neuroradiological studies is essential when planning the surgical approach to these challenging lesions. In recent years, continuous refinements of frameless stereotactic systems have come to provide the surgeon with intraoperative feedback regarding surgical orientation.…”

Section: Surgical Approachesmentioning

confidence: 99%

Skull base chordomas: overview of disease, management options, and outcome

Lanzino¹,

As²,

Mb³

et al. 2001

FOC

101

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Cranial base chordomas are locally invasive tumors that, from a midline, clival location, extend in different directions and display various patterns of skull base invasion. Although histologically benign, their invasive nature makes true “oncological” resection virtually impossible to achieve in most cases, despite modern skull base surgical techniques. Moreover, because of the tumor's location and proximity to critical neural and vascular structures, surgery-related morbidity can be significant when an aggressive resection is undertaken. Cytoreductive surgery assumes a critical role in the management of these lesions. The choice of surgical approach and the extent of resection are dependent on several factors: location and extension of the tumor, the surgeon's philosophy and familiarity with a specific approach, and the patient's preexisting clinical status. Proton-beam radiotherapy seems to be effective as an adjunct to surgery in achieving local tumor control. The timing of radiation therapy, however, remains controversial. Gamma knife surgery has been proposed as an adjunctive therapy, but the limited experience and short follow-up periods do not permit formulation of meaningful conclusions at this time. Recurrences are common, although in a subset of patients prolonged disease-free survival is demonstrated.

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Transmaxillary-Transnasal Approach to the Anterior Clivus

Cited by 14 publications

References 21 publications

The anatomic study of clival screw fixation for the craniovertebral region

The anatomic study of clival screw fixation for the craniovertebral region

The implications of microsurgical anatomy for surgical approaches to the sellar region

Skull base chordomas: overview of disease, management options, and outcome

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