Download PDF
J Neurol Surg B Skull Base 2022; 83(S 02): e374-e379
DOI: 10.1055/s-0041-1729905
Original Article

Endoscopic Endonasal Approaches to the Clivus with No Violation of the Nasopharynx: Surgical Anatomy and Clinical Illustration

Carlos D. Pinheiro-Neto
1   Department of Otorhinolaryngology—Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
,
Laura Salgado-Lopez 
2   Department of Neurosurgery, Albany Medical Center, Albany, New York, United States
,
Luciano C.P.C. Leonel 
2   Department of Neurosurgery, Albany Medical Center, Albany, New York, United States
,
Serdar O. Aydin
2   Department of Neurosurgery, Albany Medical Center, Albany, New York, United States
,
Maria Peris-Celda
2   Department of Neurosurgery, Albany Medical Center, Albany, New York, United States
3   Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States
› Author Affiliations Funding The authors deeply acknowledge the NREF for the laboratory support through the Young Clinician Investigator Award given to Maria Peris-Celda. The authors are grateful to Medtronic, Zeiss, and Storz for educational grants for the laboratory.
› Further Information
    Permissions and Reprints

Abstract

Background Despite the use of vascularized intranasal flaps, endoscopic endonasal posterior fossa defects remain surgically challenging with high rates of postoperative cerebrospinal fluid leak.

Objective The aim of the study is to describe a novel surgical technique that allows complete drilling of the clivus and exposure of the craniovertebral junction with preservation of the nasopharynx.

Methods Two formalin-fixed latex-injected anatomical specimens were used to confirm feasibility of the technique. Two surgical approaches were used: sole endoscopic endonasal approach and transnasion approach. The sole endonasal approach was used in a patient with a petroclival meningioma.

Results In both anatomical dissections, the inferior clivectomy with exposure of the foramen magnum was achieved with a sole endoscopic endonasal approach. The addition of the transnasion approach helped to complete drilling of the inferior border of the foramen magnum and exposure of the arch of C1.

Conclusion This study shows the anatomical feasibility of total clivectomy and exposure of the craniovertebral junction with preservation of the nasopharynx. A more favorable anatomical posterior fossa defect for the reconstruction is achieved with this technique. Further clinical studies are needed to assess if this change would impact the postoperative CSF leak rate.

Keywords

clivus - foramen magnum - craniovertebral junction - posterior fossa defects - endoscopic endonasal approaches - nasopharyngeal mucosa

Note

The manuscript has been accepted as a poster presentation for the NASBS meeting 2021.




Publication History

Received: 09 December 2020

Accepted: 07 March 2021

Article published online:
27 May 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Zwagerman NT, Wang EW, Shin SS. et al. Does lumbar drainage reduce postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery? A prospective, randomized controlled trial. J Neurosurg 2018; 131: 1172-1178 DOI: 10.3171/2018.4.JNS172447.
    CrossrefPubMedGoogle Scholar
  • 2 Pinheiro-Neto CD, Fernandez-Miranda JC, Rivera-Serrano CM. et al. Endoscopic anatomy of the palatovaginal canal (palatosphenoidal canal): a landmark for dissection of the vidian nerve during endonasal transpterygoid approaches. Laryngoscope 2012; 122 (01) 6-12
    CrossrefPubMedGoogle Scholar
  • 3 Pinheiro-Neto CD, Paluzzi A, Fernandez-Miranda JC. et al. Extended dissection of the septal flap pedicle for ipsilateral endoscopic transpterygoid approaches. Laryngoscope 2014; 124 (02) 391-396
    CrossrefPubMedGoogle Scholar
  • 4 Zanation AM, Snyderman CH, Carrau RL, Kassam AB, Gardner PA, Prevedello DM. Minimally invasive endoscopic pericranial flap: a new method for endonasal skull base reconstruction. Laryngoscope 2009; 119 (01) 13-18
    CrossrefPubMedGoogle Scholar
  • 5 Marigil M, Almeida JP, Karekezi C, de Almeida JR, Gentili F. Expanded endoscopic endonasal approach for resection of intradural chordoma: surgical and anatomic nuances: 2-dimensional operative video. Oper Neurosurg (Hagerstown) 2019; 17 (02) E66
    CrossrefPubMedGoogle Scholar
  • 6 Zoli M, Milanese L, Bonfatti R. et al. Clival chordomas: considerations after 16 years of endoscopic endonasal surgery. J Neurosurg 2018; 128 (02) 329-338
    CrossrefPubMedGoogle Scholar