title: Comparing operative exposures of the le fort I osteotomy and the expanded endoscopic endonasal approach to the clivus.
abstract: Objectives We compare surgical exposures to the clivus by Le Fort I osteotomy (LFO) and the expanded endoscopic endonasal approach (EEEA). Methods Ten cadaveric specimens were imaged with 1.25-mm computed tomography. After stereotactic navigation, EEEA was performed followed by LFO. Clival measurements included lateral and vertical limits to the midline lower extent of exposure (t test). Results For EEFA and LFO, respectively, maximal lateral exposure in millimeters (mean ± standard deviation) was 24.5 ± 3.7 and 24.5 ±  - 3.8 (p = 0.99) at the opticocarotid recess (OCR) and 25.1 ±  - 4.1 and 24.1 ±  - 3.0 (p = 0.53) at the foramen lacerum level; lateral reach at the hypoglossal canals was 39.0 ±  - 5.88 and 56.1 ±   - 5.3 (p = 0.0004); and vertical extension was 56.0 ±  - 4.1 and 56.3 ±  - 3.4 (p = 0.78). Conclusions For clival exposures, LFO and EEEA were similar craniocaudally and laterally at the levels of the OCR and foramen lacerum. LFO achieved greater exposure at the level of the hypoglossal canal.
authors: Department of Neurosurgery, University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, United States ; Brain Tumor Center at UC Neuroscience Institute, Cincinnati, Ohio, United States.
authors: Christopher I Sanders
authors: CI
authors: Taylor
authors: Department of Neurosurgery, University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, United States ; Brain Tumor Center at UC Neuroscience Institute, Cincinnati, Ohio, United States.
authors: Almaz
authors: A
authors: Kurbanov
authors: Department of Neurosurgery, University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, United States ; Brain Tumor Center at UC Neuroscience Institute, Cincinnati, Ohio, United States ; Department of Otolaryngology, University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, United States.
authors: Lee A
authors: LA
authors: Zimmer
authors: Department of Neurosurgery, University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, United States ; Brain Tumor Center at UC Neuroscience Institute, Cincinnati, Ohio, United States ; Mayfield Clinic, Cincinnati, Ohio, United States.
authors: Jeffrey T
authors: JT
authors: Keller
authors: Department of Neurosurgery, University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, United States ; Brain Tumor Center at UC Neuroscience Institute, Cincinnati, Ohio, United States ; Mayfield Clinic, Cincinnati, Ohio, United States.
authors: Philip V
authors: PV
authors: Theodosopoulos
keywords: Le fort I osteotomy; cadaveric study; chordoma; clivus; expanded endoscopic transsphenoidal approach; operative exposure