[Contralateral approach to clivus tumors using the transmaxillary-transethmoid approach]

A modified transmaxillary transethmoid approach to the clivus is described. A paranasal incision is performed on the side contralateral to the major tumor extension. The approach provides preservation of the lacrimal duct, and the bony structures of the pyriform aperture. By removing the frontal process of the maxilla and if necessary the medical orbital wall, a wide access is created that can be further enlarged by dissecting the medial concha, ethmoid sinus and posterior parts of the nasal septum. Cerebrospinal fluid leakage is treated by a special technique.