Endoscopic transoral-transclival approach to the brainstem and surrounding cisternal space: anatomic study.
OBJECTIVE
The purpose of this study was to review the endoscopic anatomic features of the anterior brainstem and surrounding cisternal spaces via a transoral-transclival approach.


METHODS
Fifteen adult human cadaveric heads, obtained from 10 fresh cadavers and 5 formalin-fixed cadavers, were used to demonstrate both the feasibility of an endoscopic transoral-transclival intradural approach and its exposure potential. To analyze the exact extension of a safe entry zone through the clivus, 20 skull bases were used to obtain anatomic measurements.


RESULTS
The transoral approach was performed without maxillotomy or mandibulotomy and with a clival opening of 20 by 15 mm. Such a limited clival and dural opening allowed the insertion of the endoscope and instruments, full visualization of the anterolateral brainstem and cisternal spaces around it, and reconstruction of all anatomic layers by means of a paraendoscopic technique.


CONCLUSIONS
The endoscopic transoral-transclival approach enables full access to the anterolateral brainstem and to the cisternal space around it. The use of the endoscope has the potential to reduce the need for a wider cranial base opening and the danger of postoperative complications.
de Divitiis
Oreste
O
Neurosurgical Clinic, University of Messina School of Medicine, Messina, Italy. odedivitiis@unime.it
Conti
Alfredo
A
Angileri
Filippo Flavio
FF
Cardali
Salvatore
S
La Torre
Domenico
D
Tschabitscher
Manfred
M
D000328:Adult; D001933:Brain Stem / Q000033:anatomy & histology*; D002946:Cisterna Magna / Q000033:anatomy & histology*; D003388:Cranial Fossa, Posterior / Q000601:surgery*; D004388:Dura Mater / Q000601:surgery*; D005240:Feasibility Studies; D006801:Humans; D009055:Mouth / Q000601:surgery*; D044583:Neuroendoscopy / Q000379:methods*