Display options
Cite
Cutler AR, Mundi JS, Solomon N, et al. Critical appraisal of extent of resection of clival lesions using the expanded endoscopic endonasal approach. J Neurol Surg B Skull Base. 2013;74(4):217-24doi: 10.1055/s-0033-1342915.
Cutler, A. R., Mundi, J. S., Solomon, N., Suh, J. D., Wang, M. B., & Bergsneider, M. (2013). Critical appraisal of extent of resection of clival lesions using the expanded endoscopic endonasal approach. Journal of neurological surgery. Part B, Skull base, 74(4), 217-24. https://doi.org/10.1055/s-0033-1342915
Cutler, Aaron R, et al. "Critical appraisal of extent of resection of clival lesions using the expanded endoscopic endonasal approach." Journal of neurological surgery. Part B, Skull base vol. 74,4 (2013): 217-24. doi: https://doi.org/10.1055/s-0033-1342915
Cutler AR, Mundi JS, Solomon N, Suh JD, Wang MB, Bergsneider M. Critical appraisal of extent of resection of clival lesions using the expanded endoscopic endonasal approach. J Neurol Surg B Skull Base. 2013 Aug;74(4):217-24. doi: 10.1055/s-0033-1342915. Epub 2013 Apr 12. PMID: 24436915; PMCID: PMC3715607.
Copy Download .nbib Format: NLM
Share it on

J Neurol Surg B Skull Base. 2013 Aug;74(4):217-24. doi: 10.1055/s-0033-1342915. Epub 2013 Apr 12.

Critical appraisal of extent of resection of clival lesions using the expanded endoscopic endonasal approach.

Journal of neurological surgery. Part B, Skull base

Aaron R Cutler, Jagmeet S Mundi, Noriko Solomon, Jeffrey D Suh, Marilene B Wang, Marvin Bergsneider

Affiliations

  1. Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
  2. Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
  3. Department of Radiology, David Geffen School of Medicine, University of California, Los Angeles, California, USA.

PMID: 24436915 PMCID: PMC3715607 DOI: 10.1055/s-0033-1342915

Abstract

Objectives To present a critical evaluation of our experience using an expanded endoscopic endonasal approach (EEEA) to clival lesions and evaluate, based on the location of residual tumor, what the anatomic limitations to the approach are. Design A retrospective review of all endoscopic endonasal operations performed at our institution identified 19 patients with lesions involving the clivus. Extent of resection was determined by preoperative and postoperative tumor volumes. Results Three patients underwent planned subtotal resections. Of the remaining patients, gross total resection was achieved in 8/16 (50%), > 95% in 5/16 (31%), and < 95% in 3/16 (19%). Residual tumor occurred, most commonly with extension posterior and lateral to the internal carotid artery, with inferior, lateral invasion of the occipital condyle and with deep inferior extension to the midportion of the dens. Conclusions The EEEA represents a safe and effective technique for the resection of clival lesions. Despite excellent overall visualization of this region we found that adequate exposure of the most lateral and inferior portions of large tumors is often difficult. Knowledge of these limitations allows us to determine which tumors are best suited for an EEEA and which may be more appropriate for an open skull base or combined technique.

Keywords: clival lesions; endoscopy; minimally invasive; transnasal transsphenoidal

References

  1. Neurosurgery. 2010 Jun;66(6 Suppl Operative):211-9; discussion 219-20 - PubMed
  2. Neurosurgery. 2009 Dec;65(6 Suppl):42-50; discussion 50-2 - PubMed
  3. Otolaryngol Head Neck Surg. 1984 Feb;92(1):100-1 - PubMed
  4. J Neurosurg. 1997 Feb;86(2):182-9 - PubMed
  5. Minim Invasive Neurosurg. 2004 Feb;47(1):16-23 - PubMed
  6. J Neurosurg. 2008 Nov;109(5):783-93 - PubMed
  7. Neurosurgery. 1981 Jun;8(6):675-9 - PubMed
  8. Neurosurg Focus. 2001 Mar 15;10(3):E9 - PubMed
  9. J Neurosurg. 1992 Feb;76(2):198-206 - PubMed
  10. Neurosurgery. 2006 Jul;59(1 Suppl 1):ONS50-7; discussion ONS50-7 - PubMed
  11. Neurosurgery. 2008 Aug;63(2):299-307; discussion 307-9 - PubMed
  12. Neurosurgery. 2008 May;62(5):991-1002; discussion 1002-5 - PubMed
  13. Neurosurg Focus. 2001 Mar 15;10(3):E10 - PubMed
  14. Neurosurg Focus. 2001 Mar 15;10(3):E8 - PubMed
  15. J Neurosurg. 1996 Nov;85(5):784-92 - PubMed
  16. J Neurosurg. 2010 May;112(5):1061-9 - PubMed
  17. Neurosurgery. 2004 Sep;55(3):539-47; discussion 547-50 - PubMed
  18. Neurosurgery. 2009 Mar;64(3 Suppl):ons71-82; discussion ons82-3 - PubMed
  19. Otolaryngology. 1978 Sep-Oct;86(5):ORL-770-9 - PubMed
  20. Acta Neurochir (Wien). 1988;92(1-4):83-92 - PubMed
  21. Neurosurg Focus. 2005 Jul 15;19(1):E6 - PubMed
  22. Neurosurg Focus. 2005 Jul 15;19(1):E2 - PubMed
  23. Neurosurgery. 2007 Nov;61(5 Suppl 2):212-7; discussion 217-8 - PubMed
  24. Adv Tech Stand Neurosurg. 2008;33:151-99 - PubMed
  25. Laryngoscope. 2005 Nov;115(11):1917-22 - PubMed
  26. Laryngoscope. 2006 Oct;116(10):1882-6 - PubMed
  27. Neurosurg Focus. 2001 Mar 15;10(3):E2 - PubMed
  28. Neurosurgery. 2009 Feb;64(2):268-77; discussion 277-8 - PubMed
  29. J Neurosurg. 1994 Jul;81(1):49-59 - PubMed
  30. J Neurosurg. 1966 Feb;24(2):544-51 - PubMed
  31. Neurosurg Focus. 2008;25(6):E7 - PubMed

Publication Types