Endoscopic endonasal transclival approach and retrosigmoid approach to the clival and petroclival regions.
OBJECTIVE
The removal of clival lesions, mainly those located intradurally and with a limited lateral extension, may be challenging because of the lack of a surgical corridor that would allow exposure of the entire lesion surface. In this anatomic study, we explored the clival/petroclival area and the cerebellopontine angle via both the endonasal and retrosigmoid endoscopic routes, aiming to describe the respective degree of exposure and visual limitations.


METHODS
Twelve fresh cadaver heads were positioned to simulate a semisitting position, thus enabling the use of both endonasal and retrosigmoid routes, which were explored using a 4-mm rigid endoscope as the sole visualizing tool.


RESULTS
The comparison of the 2 endoscopic surgical views (endonasal and retrosigmoid) allowed us to define 3 subregions over the clival area (cranial, middle, and caudal levels) when explored via the endonasal route. The definition of these subregions was based on the identification of some anatomic landmarks (the internal carotid artery from the lacerum to the intradural segment, the abducens nerve, and the hypoglossal canal) that limit the bone opening via the endonasal route and the natural well-established corridors via the retrosigmoid route.


CONCLUSIONS
Different endoscopic surgical corridors can be delineated with the endonasal transclival and retrosigmoid approaches to the clival/petroclival area. Some relevant neurovascular structures may limit the extension of the approach and the view via both routes. The combination of the 2 approaches may improve the visualization in this challenging area.
de Notaris
Matteo
M
Division of Neurosurgery, Department of Neurological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy.
Cavallo
Luigi Maria
LM
Prats-Galino
Alberto
A
Esposito
Isabella
I
Benet
Arnau
A
Poblete
José
J
Valente
Vinicio
V
Gonzalez
Joan Berenguer
JB
Ferrer
Enrique
E
Cappabianca
Paolo
P
D000010:Abducens Nerve / Q000033:anatomy & histology; D015415:Biomarkers; D002102:Cadaver; D002343:Carotid Artery, Internal / Q000033:anatomy & histology; D002530:Cerebellopontine Angle / Q000033:anatomy & histology / Q000601:surgery; D003388:Cranial Fossa, Posterior / Q000033:anatomy & histology / Q000601:surgery*; D003392:Cranial Sinuses / Q000033:anatomy & histology / Q000601:surgery*; D003399:Craniotomy / Q000295:instrumentation / Q000379:methods; D004724:Endoscopy / Q000379:methods*; D006801:Humans; D007002:Hypoglossal Nerve / Q000033:anatomy & histology; D009296:Nasal Cavity / Q000033:anatomy & histology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods; D010579:Petrous Bone / Q000033:anatomy & histology / Q000601:surgery*; D011300:Preoperative Care; D019292:Skull Base Neoplasms / Q000601:surgery
D015415:Biomarkers