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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
The transnasal transclival approach for clivus chordoma
D Holzmann1, R Reisch, N Krayenbühl
1Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland. David.Holzmann@usz.ch
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.
