title: Stereotactic biopsy approach to the upper clivus through the middle fossa floor that avoids pneumatised cavities and the intradural compartment.
abstract: BACKGROUND
  Biopsies of clival lesions are usually performed, under general anaesthesia, through an anterior endoscopic approach or, alternatively, through a trans-nasal or trans-oral stereotactic approach.
  
  
  METHODS
  A 57-year-old man with a symptomatic osteolytical lesion of the clivus, who refused general anaesthesia, underwent a sterotactically guided biopsy of the lesion by an antero-lateral approach through the temporal and sphenoid bones.
  
  
  RESULTS
  Biopsy was successfully performed and the resulting diagnosis was myeloma. The patient was comfortable during and after surgery and there were no complications.
  
  
  CONCLUSIONS
  The present stereotactic antero-lateral approach to the biopsy of the upper clivus can be considered an useful adjunct to the current trans-oral and transnasal approaches that often require general anaesthesia.
authors: Neurosurgical Unit, Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Fondazione IRCCS Policlinico S. Matteo, V. le Golgi 19, 27100, Pavia, Italy. lorenzo.magrassi@unipv.it.
authors: Lorenzo
authors: L
authors: Magrassi
authors: Neurosurgical Unit, Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Fondazione IRCCS Policlinico S. Matteo, V. le Golgi 19, 27100, Pavia, Italy.
authors: Elena
authors: E
authors: Moretti
authors: Department of Neuropathology, Southmead Hospital, Bristol, BS10 5NB, UK.
authors: Marco
authors: M
authors: Marchionni
authors: Neuroradiology Unit, National Neurological Institute IRCCS Fondazione C. Mondino, Pavia, Italy.
authors: Elisa
authors: E
authors: Rognone
authors: Department of Haematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors: Bonfichi
authors: B
authors: Maurizio
mesh_terms: D001706:Biopsy / Q000379:methods; D004388:Dura Mater / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000473:pathology* / Q000601:surgery; D044583:Neuroendoscopy / Q000379:methods*; D038361:Neuronavigation / Q000379:methods*; D019291:Skull Base / Q000601:surgery*; D012888:Skull Neoplasms / Q000473:pathology* / Q000601:surgery
keywords: Clivus; Local anaesthesia; Stereotactic biopsy