title: Full endoscopic endonasal transclival approach: meningioma attached to the ventral surface of the brainstem.
abstract: BACKGROUND
  Intracranial meningiomas without dural attachment (MWODA) are rare entities. We present the first case published, to the best of our knowledge, regarding a MWODA attached to the ventral surface of the brainstem. This location makes the patient subsidiary to treatment through an expanded endonasal transclival approach.
  
  
  METHODS
  A 16-year-old female with suspected diagnosis of recurrence of a clear cell meningioma (CCM) at a distance from the initial lesion, located on the premedullary cistern. The patient underwent a pure endoscopic low transclival approach. The attachment to the ventral surface of the brainstem was confirmed intraoperatively. Postoperative MRI confirmed gross total resection and treatment was complemented with adjuvant fractionated stereotactic radiotherapy. No complications related to the procedure were observed.
  
  
  CONCLUSIONS
  MWODA may appear attached to the ventral brainstem. The expanded endonasal approach to the clivus provides a critical anatomical advantage in the treatment of medial lesions, even ventral meningiomas, to the lower cranial nerves. Reconstruction principles must be strictly respected to reduce complications.
authors.affiliation: Neurosurgical Department, HUyP La Fe de Valencia, Valencia, Spain. Electronic address: juanantonio.simal@gmail.com.
authors.forename: Juan Antonio
authors.initials: JA
authors.lastname: Simal Julian
authors.affiliation: Neurosurgical Department, HUyP La Fe de Valencia, Valencia, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Sanromán Álvarez
authors.affiliation: Neurosurgical Department, HUyP La Fe de Valencia, Valencia, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Miranda Lloret
authors.affiliation: Neurosurgical Department, HUyP La Fe de Valencia, Valencia, Spain.
authors.forename: Estela
authors.initials: E
authors.lastname: Plaza Ramirez
authors.affiliation: Neurosurgical Department, HUyP La Fe de Valencia, Valencia, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Pérez Borreda
authors.affiliation: Neurosurgical Department, HUyP La Fe de Valencia, Valencia, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Botella Asunción
mesh_terms: D000293:Adolescent; D020295:Brain Stem Neoplasms / Q000601:surgery*; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D008579:Meningioma / Q000601:surgery*; D009666:Nose
keywords: Abordaje transclival; Dural attachment; Endonasal; Endoscope; Endoscopio; Implantación dural; Meningioma; Transclival approach