Transpterygoid Corridor for Upper Clival Chondrosarcoma: Understanding the Key Landmarks and Technical Nuances

Area of Science:

• Neurosurgery
• Endoscopic Skull Base Surgery
• Oncology

Background:

• Clival lesions present significant surgical challenges due to their location and invasive nature.
• Traditional approaches may require extensive brain retraction.
• Minimally invasive techniques are sought for better patient outcomes.

Purpose of the Study:

• To demonstrate the surgical technique for endoscopic transsphenoidal, transpterygoid, transclival excision of upper clival chondrosarcoma.
• To highlight the advantages of the transpterygoid approach in accessing clival tumors.
• To evaluate the efficacy of this technique in achieving gross total resection and preserving neurological function.

Main Methods:

• Video demonstration of endoscopic excision of a chondrosarcoma involving the upper clivus and petroclival synchondrosis.
• Patient positioning in supine position with lumbar drain.
• Identification of key anatomical landmarks: Vidian nerve, pterygosphenoidal fissure, foramen lacerum, and paraclival internal carotid artery.

Main Results:

• The endoscopic transpterygoid approach provided direct tumor access with minimal brain retraction.
• Gross total resection (R0 oncological resection) was achieved.
• The procedure resulted in minimal new-onset neurological deficits.

Conclusions:

• Endoscopic transsphenoidal, transpterygoid, transclival surgery is an effective method for resecting upper clival tumors.
• This approach facilitates oncological resection while preserving neurological function.
• The technique significantly improves the quality of life for patients with clival chondrosarcoma.