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Related Experiment Videos

A modified transfacial approach to the clivus

B Swearingen1, M Joseph, M Cheney

  • 1Neurosurgical Service, Massachusetts General Hospital, Boston.

Neurosurgery
|January 1, 1995
PubMed
Summary

This study presents a modified transfacial approach for accessing the clivus, offering improved visualization and cosmetic outcomes. The technique is effective for treating clival tumors and vertebrobasilar aneurysms.

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Area of Science:

  • Neurosurgery
  • Otolaryngology
  • Head and Neck Surgery

Background:

  • Anterior clival access requires optimal lesion visualization, dural repair access, and cosmetic results.
  • Current transnasal and transoral methods often involve extensive palatal, maxillary, or mandibular splitting for adequate exposure.

Observation:

  • A modified transfacial approach utilizing a lateral rhinotomy incision.
  • The technique involves bilateral osteotomy of nasal bones, rotating the nose on a pedicle flap to expose the nasal cavity.
  • Removal of the septum and medial maxillary walls enhances visualization of the anterior skull base and upper aerodigestive tract.

Findings:

  • This modified approach provides excellent rostrocaudal access to the clivus.
  • It offers superior visualization of the ethmoid, sphenoid, posterior nasopharynx, and upper oropharynx.

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  • The procedure allows for good cosmetic closure of the nasal incision.

    • Implications:

    • This technique offers a viable alternative for managing complex clival pathologies.
    • It is applicable to tumors such as chordoma and midline aneurysms of the vertebrobasilar system.
    • The approach potentially improves surgical outcomes and patient cosmesis for anterior skull base procedures.