title: Reconstructive challenges in the extended endoscopic transclival approach.
abstract: OBJECTIVE
  We wanted to present our experience with the extended endoscopic approach to clival pathology, focusing on cerebrospinal fluid leak and reconstruction challenges.
  
  
  METHODS
  We examined a consecutive series of 37 patients undergoing the extended endoscopic approach for skull base tumours, 9 patients with clival pathology. Patients were examined for the incidence of post-operative cerebrospinal fluid leak in relation to tumour pathology, location, size, reconstruction and lumbar drain.
  
  
  RESULTS
  The overall incidence of post-operative cerebrospinal fluid leak was 10.8 per cent. Seventy-five per cent of patients who had a post-operative cerebrospinal fluid leak underwent a transclival approach (p < 0.05). All patients with clival pathology who underwent an intradural dissection had a post-operative cerebrospinal fluid leak (p < 0.05).
  
  
  CONCLUSIONS
  Post-operative cerebrospinal fluid leak rates after the extended endoscopic approach have improved significantly after advancements including the vascularised nasoseptal flap. Despite this, transclival approaches continue to pose much difficulty. Further investigation is necessary to develop technical improvements that can meet the unique challenges associated with this region.
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery,Hospital of the University of Pennsylvania,Philadelphia,USA.
authors.forename: A
authors.initials: A
authors.lastname: Kamat
authors.affiliation: Department of Neurosurgery,Hospital of the University of Pennsylvania,Philadelphia,USA.
authors.forename: J Y K
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery,Hospital of the University of Pennsylvania,Philadelphia,USA.
authors.forename: G H
authors.initials: GH
authors.lastname: Goldstein
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery,Hospital of the University of Pennsylvania,Philadelphia,USA.
authors.forename: J G
authors.initials: JG
authors.lastname: Newman
authors.affiliation: Department of Neurosurgery,Hospital of the University of Pennsylvania,Philadelphia,USA.
authors.forename: P B
authors.initials: PB
authors.lastname: Storm
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery,Hospital of the University of Pennsylvania,Philadelphia,USA.
authors.forename: J N
authors.initials: JN
authors.lastname: Palmer
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery,Hospital of the University of Pennsylvania,Philadelphia,USA.
authors.forename: N D
authors.initials: ND
authors.lastname: Adappa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D065634:Cerebrospinal Fluid Leak / Q000453:epidemiology / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D003388:Cranial Fossa, Posterior / Q000473:pathology / Q000601:surgery*; D004724:Endoscopy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods; D019292:Skull Base Neoplasms / Q000473:pathology / Q000601:surgery*; D013524:Surgical Flaps; D055815:Young Adult
keywords: Cerebrospinal Fluid Leak; Cranial Fossa; Endoscopy; Minimally Invasive Surgical Procedures; Natural Orifice Endoscopic Surgery; Posterior; Skull Base