Extended endoscopic endonasal approach to clival and paraclival tumors: Indications and limits

• Published in: Neuro-chirurgie 2016-06, Vol.62 (3), p.136-145
• Main Authors: Messerer, M, Cossu, G, Pasche, P, Ikonomidis, C, Simon, C, Pralong, E, George, M, Levivier, M, Daniel, R.T
• Format: Article
• Language: English
• Subjects: Adult; Antineoplastic Agents - therapeutic use; Chirurgie de la base du crâne; Chordome; Clival chordoma; Clival meningioma; Clivus; Combined Modality Therapy; Cranial Fossa, Posterior - surgery; Cranial Irradiation; Cranial Nerve Diseases - epidemiology; Cranial Nerve Diseases - etiology; Endoscopie; Endoscopy - methods; Extended endoscopic endonasal approach; Female; Humans; Male; Middle Aged; Monitoring, Intraoperative; Méningiome; Nasal Cavity; Neurosurgery; Postoperative Complications - epidemiology; Radiosurgery; Remission Induction; Retrospective Studies; Skull Base Neoplasms - drug therapy; Skull Base Neoplasms - radiotherapy; Skull Base Neoplasms - secondary; Skull Base Neoplasms - surgery; Skull base surgery; Surgery; Young Adult
• ISSN: 0028-3770; 1773-0619
• DOI: 10.1016/j.neuchi.2015.12.003

Abstract Objective To report our experience with the Extended endoscopic endonasal approach (EEEA) for clival and paraclival tumors. Design 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.