Article
Endoscopic endonasal extradural posterior clinoidectomy for skull base tumour
Endoskopische endonasale extradurale posteriore Clinoidektomie bei Schädelbasistumor
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Published: | June 26, 2020 |
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Outline
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Objective: The endoscopic endonasal approach for skull base tumors has become an important topic in recent years, but its use, merits, and demerits are still being debated. The objective of this study was to describe the surgical implementation and efficacy of the endoscopic endonasal extradural posterior clinoidectomy to obtain maximal tumor exposure.
Methods: The surgical technique included extradural posterior clinoidectomy following lateral retraction of the internal carotid artery at the paraclival segment and extradural pituitary retraction. In cases with prominent posterior clinoid process, the sellar dura was cut midline to facilitate extradural exposure of the process. Forty-four consecutive patients in whom this technique was performed between 2016 and 2018 at the authors’ institution were reviewed. The pathology included 19 craniopharyngiomas, 7 chordomas, 6 meningiomas, 6 pituitary adenomas, 4 chondrosarcomas, and 2 miscellaneous. Utilization and effectiveness of this approach were further demonstrated with the radiological study of clinical cases.
Results: All cases were successfully operated using this procedure without any neurovascular injury, and it facilitated greater resection of the tumors. Four patients experienced transient postoperative abducens nerve paresis, and one patient experienced transient postoperative oculomotor nerve paresis; however, the deficits recovered within 3 months. On radiological examination, the surgical field was 2.2 times wider in cases with bilateral posterior clinoidectomy than in cases without posterior clinoidectomy.
Conclusion: The endoscopic endonasal approach with posterior clinoidectomy increases the working space and the maneuverability of the instruments to remove the tumor extended behind the posterior clinoid and dorsum sellae.