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Updated: Jun 9, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Clinical Outcome of Extended Endoscopic Endonasal Transclival Approach for Skull Base Lesions
Alejandro Vargas-Moreno1, Sami Khairy1, Mouaz Saymeh2
1Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
Background And Objectives:
Surgical access to the clival region remains a significant challenge because of its midline location, deep anatomic position, and complex neurovascular relationships. The extended endoscopic endonasal approach (EEA) offers a direct, minimally invasive corridor to this intricate region of the skull base. This study presents a comprehensive review of the clinical presentation, surgical indications, and outcomes in a series of 46 patients who underwent EEA for lesions involving the clivus.
Methods:
This was a retrospective study in which we identified cases of clival pathologies through our institution's skull base database from October 2014 and October 2024 based on our inclusion and exclusion criteria.
Results:
Surgical indications included lesions at the craniovertebral junction, specifically craniovertebral junction instability requiring endonasal odontoidectomy in 15 patients (32.6%) and space-occupying lesions in the remaining 31 patients (67.4%). Among the latter, chordomas were the most common histopathological diagnosis. Clinical symptoms varied according to tumor location and underlying pathology. The extent of resection and the use of adjuvant radiotherapy were tailored to histopathological subtype. In patients with space-occupying lesions, gross total resection (GTR) was achieved in 46.7% of cases, while adjuvant radiotherapy was administered in 18 patients (38.1%). In cases of chordoma, GTR was more frequently achieved in smaller tumors (mean volume: 9.3 cm3 vs 12.6 cm3; P = .359) and in those confined to the midline. Furthermore, GTR was associated with improved cranial nerve function during follow-up. Residual tumors were most frequently observed in the cavernous sinus and retro-paraclival carotid regions.
Conclusion:
Based on our experience, the EEA represents a safe and effective surgical option for clival lesions, with potential benefits including avoidance of craniotomy and brain retraction, reduced neurovascular manipulation, and lower surgical morbidity.
