Alexey N Shkarubo1, Konstantin V Koval1, Mikhail A Shkarubo1, Ilia V Chernov2, Dmitry N Andreev1, Andrey A Panteleyev3. 1. Department of Neurooncology, Federal State Autonomous Institution, N. N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russia. 2. Department of Neurooncology, Federal State Autonomous Institution, N. N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russia. Electronic address: ichernov@nsi.ru. 3. Department of Spinal Pathology, N. N. Priorov Central Institute of Traumatology and Orthopedics, Moscow, Russia.
Abstract
OBJECTIVE: To present the basic topographic and anatomic features of the clivus and adjacent structures with an objective of possible improvements and optimization of the extended endoscopic endonasal posterior (transclival) approach when removing tumors of the clivus and anterior regions of the posterior cranial fossa. MATERIALS AND METHODS: A craniometric study was conducted on 125 human skulls. A topographic anatomic study was conducted on 25 cadaver head specimens with arterial and venous beds stained with colored silicone, according to the method developed by us, to visualize its features and individual variability. RESULTS: The most important anatomic features of the external and internal regions of the clivus and the adjacent neural and vascular structures were analyzed. An accessible zone for the most effective transclival approach to the posterior cranial fossa is also specified. CONCLUSION: The endoscopic endonasal transclival approach can be used to obtain access to centrally located tumors of the posterior cranial fossa. It is an alternative to transcranial approaches in the surgical treatment of tumors of the clivus.
OBJECTIVE: To present the basic topographic and anatomic features of the clivus and adjacent structures with an objective of possible improvements and optimization of the extended endoscopic endonasal posterior (transclival) approach when removing tumors of the clivus and anterior regions of the posterior cranial fossa. MATERIALS AND METHODS: A craniometric study was conducted on 125 human skulls. A topographic anatomic study was conducted on 25 cadaver head specimens with arterial and venous beds stained with colored silicone, according to the method developed by us, to visualize its features and individual variability. RESULTS: The most important anatomic features of the external and internal regions of the clivus and the adjacent neural and vascular structures were analyzed. An accessible zone for the most effective transclival approach to the posterior cranial fossa is also specified. CONCLUSION: The endoscopic endonasal transclival approach can be used to obtain access to centrally located tumors of the posterior cranial fossa. It is an alternative to transcranial approaches in the surgical treatment of tumors of the clivus.
Keywords:
Chordoma of clivus; Clivus; Endoscopic endonasal surgery of skull base; Endoscopic endonasal transclival approach; Monitoring of cranial nerves; Posterior cranial fossa; Skull base anatomy
Authors: Bryan Lubomirsky; Zachary B Jenner; Morgan B Jude; Kiarash Shahlaie; Reza Assadsangabi; Vladimir Ivanovic Journal: Neuroradiol J Date: 2021-12-02