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

Clival lesions pose a unique challenge owing to their location and locally invasive nature. A transpterygoid approach gives the advantage of direct access to the tumor without much brain retraction. This video shows the surgical technique of endoscopic transsphenoidal, transpterygoid, transclival excision of a chondrosarcoma involving the upper third of the clivus and the petroclival synchondrosis. The patient was positioned in the supine position after insertion of lumbar drain. After the nasal stage, the Vidian nerve and pterygosphenoidal fissure were identified, which helps in localization of the foramen lacerum and paraclival internal carotid artery. These structures aid spatial orientation and precise drilling, hence facilitating gross total resection akin to a complete (R0) oncological resection. Endoscopic-transpterygoid helps in achieving gross total resection of upper clival tumors with minimal new-onset neurological deficits leading to significant improvement in the quality of life of the patient.