Ventral Brainstem Anatomy: An Endoscopic Transoral Perspective

Area of Science:

• Neurosurgery
• Minimally Invasive Surgery
• Endoscopic Techniques

Background:

• The transclival route using endoscopy is gaining attention for treating various clival pathologies.
• Minimally invasive approaches are crucial for accessing complex cranial base regions.

Purpose of the Study:

• To describe the endoscopic anatomy of the transoral-transclival region.
• To demonstrate the feasibility and exposure potential of an endoscopic transoral-transclival intradural approach.

Main Methods:

• Utilized fresh and formalin-fixed cadaver specimens.
• Performed an endoscopic transoral approach with a 20x15 mm clival opening.
• Assessed the exposure of cisternal spaces and anatomical layer reconstruction.

Main Results:

• The endoscopic transoral-transclival approach allowed complete exposure of cisternal spaces.
• A smaller clival opening did not limit anatomical visualization or reconstruction.
• The technique respected anatomical structures while remaining minimally invasive.

Conclusions:

• The endoscopic transoral-transclival approach provides excellent exposure of challenging ventral brainstem and cisternal areas.
• Further clinical experience is required to establish its safety and efficacy.
• This approach holds promise for treating lesions in these difficult-to-access regions and developing new surgical strategies.