Endoscopic transsphenoidal biopsy of the sphenoid and clival mass

Abnormalities of the clivus/skull base occur most commonly as a result of disease spread from adjacent structures, but can also occur from primary involvement of the clivus. Traditionally, definitive diagnosis was made by CT guided biopsy or craniotomy. However, lesions can occur in this area that are not amenable to CT guided biopsy or craniotomy. Endoscopic transsphenoidal surgery can provide a safe method for obtaining a clival biopsy, debulking of tumor tissue, or definitive treatment without the morbidity and mortality of a craniotomy. This study was designed to describe our experience with the endoscopic approach to the skull base and clivus via the sphenoid sinus. A series of seven patients underwent endoscopic transsphenoidal biopsy of a sphenoid clival lesion. All patients avoided anticipated craniotomy, and definitive pathology was obtained in five of six patients. In two cases, excisional biopsy proved to be therapeutic. There were no deaths, and major complications included one CSF leak and one intraoperative hemorrhage, both of which were controlled immediately. The experience gained with these patients demonstrates the feasibility and safety of this new application of endoscopic sinus surgery for the diagnosis and possible treatment of lesions of the sphenoid and clivus.