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Updated: Jun 10, 2026
Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
Endoscopic endonasal minimal access approach to the clivus: case series and technical nuances
Justin F Fraser1, Gurston G Nyquist, Nicholas Moore
1Department of Neurosurgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York 10065, USA.
Background:
The endoscopic endonasal transclival approach is a novel minimal-access method of managing clival pathology. Limited cases have been published.
Objective:
To summarize our clinical experience with this approach and discuss technical nuances.
Methods:
We retrospectively reviewed a prospective database of 250 endoscopic, endonasal skull base surgeries. Patients in whom a transclival approach was performed were identified. Extent of resection, complications, and clinical outcome were analyzed.
Results:
Seventeen patients underwent 21 procedures. Pathology included chordoma, meningioma, hemangiopericytoma, enterogenous cyst, epidermoid, and metastasis. Lumbar drain was placed intraoperatively in 9 cases and maintained for approximately 2 days postoperatively. Mean operative time was 252.8 minutes. Intraoperative cerebrospinal fluid (CSF) leak occurred in 10 cases. Greater than 95% resection was achieved in 11 of 12 cases (92%) in which it was the surgical goal. The risk of postoperative CSF leak was 4.8% for all procedures, 9.1% for procedures with large skull base defect, and 0% if a gasket-seal closure was achieved. A nasoseptal flap was used in 2 patients. There was one perioperative infarct, one case of deep vein thrombosis, and one postoperative pulmonary embolus. Mean follow-up was 8.5 months. All but one patient with preoperative cranial nerve deficits improved at last follow-up. All patients were free of disease progression at last follow-up.
Conclusions:
The endonasal endoscopic transclival approach provides a minimal-access approach to the ventral midline posterior fossa skull base. The risk of CSF leak is low if appropriate closure techniques are applied.
