title: Improving the endoscopic endonasal transclival approach: the importance of a precise layer by layer reconstruction.
abstract: BACKGROUND. The endoscopic endonasal transclival approach (EETCA) is a minimally-invasive technique allowing a direct route to the base of implant of clival lesions with reduced brain and neurovascular manipulation. On the other hand, it is associated with potentially severe complications related to the difficulties in reconstructing large skull base defects with a high risk of postoperative cerebrospinal fluid (CSF) leakage. The aim of this paper is to describe a precise layer by layer reconstruction in the EETCA including the suture of the mucosa as an additional reinforcing layer between cranial and nasal cavity in order to speed up the healing process and reduce the incidence of CSF leak. METHODS. This closure technique was applied to the last six cases of EETCA used for clival meningiomas (2), clival chordomas (2), clival metastasis (1), and craniopharyngioma with clival extension (1). RESULTS. After a mean follow-up of 6 months we had no one case of postoperative CSF leakage or infections. Seriated outpatient endoscopic endonasal controls showed a fast healing process of nasopharyngeal mucosa with less patient discomfort. CONCLUSIONS. Our preliminary experience confirms the importance of a precise reconstruction of all anatomical layers violated during the surgical approach, including the nasopharygeal mucosa.
authors.affiliation: Department of Neurosurgery, Università Politecnica delle Marche, Umberto I General Hospital , Ancona , Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Iacoangeli
authors.forename: Alessandro
authors.initials: A
authors.lastname: Di Rienzo
authors.forename: Lucia Giovanna Maria
authors.initials: LG
authors.lastname: di Somma
authors.forename: Elisa
authors.initials: E
authors.lastname: Moriconi
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Alvaro
authors.forename: Massimo
authors.initials: M
authors.lastname: Re
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Salvinelli
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Carassiti
authors.forename: Massimo
authors.initials: M
authors.lastname: Scerrati
mesh_terms: D001268:Atlanto-Axial Joint; D001269:Atlanto-Occipital Joint; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000453:epidemiology; D002817:Chordoma / Q000601:surgery; D003388:Cranial Fossa, Posterior / Q000601:surgery; D003397:Craniopharyngioma / Q000601:surgery; D004724:Endoscopy / Q000379:methods*; D006801:Humans; D008579:Meningioma / Q000601:surgery; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009092:Mucous Membrane / Q000502:physiology; D009296:Nasal Cavity / Q000601:surgery*; D009305:Nasopharynx / Q000502:physiology; D019651:Plastic Surgery Procedures / Q000379:methods; D019292:Skull Base Neoplasms / Q000601:surgery; D013530:Surgical Wound Infection / Q000453:epidemiology; D013537:Sutures