Abstract
Background: We present our experience using a standardized transnasal transclival approach (TTA)
for endoscopic removal of chordomas of the clivus.
Patients: 13 patients with clival chordoma (CC) underwent tumor resection. Patients were operated
by a surgical team consisting of a rhinosurgeon and a neurosurgeon. All patients underwent
postoperative proton radiotherapy. Residual tumor was left in situations where radical
removal would have entailed an increased risk of neurological deficits.
Results: Radical or near total removal of CC was accomplished in 12/13 patients. Intraoperative
MRI (IMRI) was used in 4/13 CC patients. A watertight dural seal presented as the
main challenge specifically for tumor extensions resulting in large dural defects.
Conclusion: The TTA provides an elegant alternative to classical approaches to clival lesions
especially for midline tumor locations. For large tumors iMRI is of significant help.
Dural reconstruction of large defects emerged as the greatest challenge of this technique
even for experienced endoscopic surgeons.
Key words
endoscopic surgery - chordoma - skull base surgery - transsphenoidal surgery - intraoperative
MRI - minimally invasive surgery
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Correspondence
D. HolzmannMD
Department of Otorhinolaryngology
Head and Neck Surgery
University Hospital
CH-8091 Zurich
Switzerland
Phone: +41/44/255 5855
Fax: +41/44/255 45 56
Email: David.Holzmann@usz.ch