title: Extended endoscopic endonasal approach to clival and paraclival tumors: Indications and limits.
abstract: OBJECTIVE
  To report our experience with the Extended endoscopic endonasal approach (EEEA) for clival and paraclival tumors.
  
  
  METHODS
  Retrospective analysis of a consecutive series of patients.
  
  
  RESULTS
  Eleven patients were considered: 3 chordomas, 3 meningiomas, 3 metastatic lesions, one chondroma and one chondrosarcoma. Gross total resection (GTR) was achieved in all chordomas and in chondromas with patients free of disease at the last follow-up. The chondrosarcoma was first operated on using a transfacial approach and endoscopy was performed for local progression with subtotal resection. The meningiomas were treated by a combination of transcranial and endoscopic approach due to their extension. The resection was subtotal and the residue treated by radiosurgery. Two patients with rhinopharyngeal carcinoma underwent palliative debulking. One metastatic melanoma that underwent GTR experienced remission. Two patients had postoperative cranial nerve palsy. No other complications were observed.
  
  
  CONCLUSIONS
  EEEA allows a direct access to the skull base. Through a minimal access, it limits the incidence of neurological morbidities. For midline epidural clival tumors, EEEA allows a total excision. It also offers an excellent access to the clival component of intradural lesions. A combined approach permits good tumor control with minimal complications.
authors.affiliation: Département des neurosciences cliniques, service de neurochirurgie, centre hospitalier universitaire Vaudois, université de Lausanne, rue du Bugnon 44, 1011 Lausanne, Switzerland; Département de neurochirurgie, hôpital Kremlin-Bicêtre, université de Paris Sud, 94270 Paris, France. Electronic address: Mahmoud.messerer@chuv.ch.
authors.forename: M
authors.initials: M
authors.lastname: Messerer
authors.affiliation: Département des neurosciences cliniques, service de neurochirurgie, centre hospitalier universitaire Vaudois, université de Lausanne, rue du Bugnon 44, 1011 Lausanne, Switzerland.
authors.forename: G
authors.initials: G
authors.lastname: Cossu
authors.affiliation: Service d'otorhinolaryngologie, centre hospitalier universitaire Vaudois, université de Lausanne, UNIL, 1011 Lausanne, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Pasche
authors.affiliation: Service d'otorhinolaryngologie, centre hospitalier universitaire Vaudois, université de Lausanne, UNIL, 1011 Lausanne, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Ikonomidis
authors.affiliation: Service d'otorhinolaryngologie, centre hospitalier universitaire Vaudois, université de Lausanne, UNIL, 1011 Lausanne, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Simon
authors.affiliation: Département des neurosciences cliniques, service de neurochirurgie, centre hospitalier universitaire Vaudois, université de Lausanne, rue du Bugnon 44, 1011 Lausanne, Switzerland.
authors.forename: E
authors.initials: E
authors.lastname: Pralong
authors.affiliation: Département de neurochirurgie, hôpital Kremlin-Bicêtre, université de Paris Sud, 94270 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: George
authors.affiliation: Département des neurosciences cliniques, service de neurochirurgie, centre hospitalier universitaire Vaudois, université de Lausanne, rue du Bugnon 44, 1011 Lausanne, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Levivier
authors.affiliation: Département des neurosciences cliniques, service de neurochirurgie, centre hospitalier universitaire Vaudois, université de Lausanne, rue du Bugnon 44, 1011 Lausanne, Switzerland.
authors.forename: R T
authors.initials: RT
authors.lastname: Daniel
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003388:Cranial Fossa, Posterior / Q000601:surgery*; D016371:Cranial Irradiation; D003389:Cranial Nerve Diseases / Q000453:epidemiology / Q000209:etiology; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009296:Nasal Cavity; D011183:Postoperative Complications / Q000453:epidemiology; D016634:Radiosurgery; D012074:Remission Induction; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery*; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents
keywords: Chirurgie de la base du crâne; Chordome; Clival chordoma; Clival meningioma; Clivus; Endoscopie; Extended endoscopic endonasal approach; Méningiome; Skull base surgery