Transnasal endoscopic and lateral approaches to the clivus: a quantitative anatomical study.

Transnasal endoscopic and lateral approaches to the clivus: a quantitative anatomical study.

World Neurosurg. 2018 Feb 27;:

Authors: Doglietto F, Ferrari M, Mattavelli D, Belotti F, Rampinelli V, Kheshaifati H, Lancini D, Schreiber A, Sorrentino T, Ravanelli M, Buffoli B, Hirtler L, Maroldi R, Nicolai P, Rodella L, Fontanella MM

Abstract
BACKGROUND: Transnasal endoscopic approaches to the clivus have been recently established. Comparative analyses with "classic" lateral approaches are limited.
OBJECTIVE: To compare transnasal endoscopic and lateral approaches to the clivus, quantifying exposure and working volume of each approach in the anatomy laboratory.
MATERIALS AND METHODS: Five injected specimens (10 sides) underwent high-resolution computed tomography. In each specimen, transnasal endoscopic (Paraseptal, Transrostral, Extended Transrostral, Transethmoidal, Extended Transclival approach without and with intradural hypophysiopexy) and lateral approaches (Retrosigmoid, Far-lateral, Presigmoid retro- and trans-labyrinthine) to the clivus were performed. An optic neuronavigation system and dedicated software (ApproachViewer-GTx-UHN, Toronto, Canada) were used to quantify working volume and exposed clival area of each approach. Statistical evaluation was performed with Kruskal-Wallis test and Steel-Dwass-Critchlow-Fligner post-hoc test.
RESULTS: Endoscopic transnasal transclival approaches showed higher working volume and larger clival exposure compared to lateral approaches. Incremental volumetric values were evident for transnasal approaches; pre-sigmoid approaches provided less working volume than retrosigmoid ones. A transnasal transclival approach with hypophysiopexy provided significant exposure of the upper clivus (84.4%). The transrostral approach was the first transnasal approach providing satisfactory access to the midclivus (66%); retrosigmoid and far-lateral approaches provided exposure of approximately half of it. The lower clivus was optimally exposed with endoscopic transclival approaches (83%), while access to this region was limited with lateral approaches.
CONCLUSIONS: This quantitative anatomical study shows that endoscopic transnasal approaches to the clivus provide larger working volume and wider exposure of the clivus than lateral approaches.

PMID: 29499424 [PubMed - as supplied by publisher]

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