Endoscopic management of sphenoclival neoplasms: anatomical correlates and patient outcomes.
OBJECTIVE
To characterize the endoscopic anatomy of the sphenoid sinus and the adjacent clivus and cavernous sinus, and to review patient outcomes for neoplasms in this region.


METHODS
Cadaver dissection and chart review.


METHODS
Cadaver laboratory and tertiary care center.


METHODS
Fresh-frozen cadaver heads were dissected to study the endoscopic anatomy of the sphenoclival region. Retrospective chart review of patients undergoing endoscopic resection of sphenoclival neoplasms between 2000 and 2008 was performed.


RESULTS
Transnasal endoscopic access to the sphenoid sinus was obtained in 10 cadaver heads. A clival window with mean dimensions of 1.4 cm x 1.7 cm was created. Through the clival window, identification and dissection of the basilar and vertebral arteries, mamillary bodies, third ventricle, cranial nerves III through VI, and cervical rootlets were possible. Nineteen patients with mean age of 56.2 years were treated. The most common pathologies were inverted papilloma (5), chordoma (4), squamous cell carcinoma (2), and adenoid cystic carcinoma (2). None of the patients required adjunct craniotomies. Nine patients received adjuvant therapies. Thirteen (68.4%) patients had no evidence of disease, five (26.3%) patients were alive with disease, and one (5.3%) patient died of disease at mean follow-up of 32.6 months.


CONCLUSIONS
The sphenoclival region poses a significant surgical challenge given its central location at the skull base and proximity to critical structures. This study demonstrates that transnasal endoscopic access to the sphenoclival region is technically feasible and allows successful surgical extirpation of tumors with a low complication rate and acceptable patient outcomes.
Solares
C Arturo
CA
Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, Augusta, GA, USA.
Grindler
David
D
Luong
Amber
A
Kanowitz
Seth J
SJ
Sade
Burak
B
Citardi
Martin J
MJ
Batra
Pete S
PS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002817:Chordoma / Q000601:surgery; D003388:Cranial Fossa, Posterior; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000379:methods*; D018308:Papilloma, Inverted / Q000601:surgery; D010255:Paranasal Sinus Neoplasms / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000601:surgery*; D013101:Sphenoid Sinus