Abstract
A.B.
Kassam; C.H.
Snyderman; A. Mintz; P. Gardner*; R.L. Carrau
Objective
Transsphenoidal
approaches have been used for a century for the resection of pituitary and
other sellar tumors. Recently, however, the standard endonasal approach has
been expanded to provide access to other parasellar lesions. With the addition
of the endoscope, this expansion has significant potential for the resection of
skull base lesions.
Methods
The anatomical
landmarks and surgical techniques used in expanded (extended) endoscopic
approaches to the clivus and cervicomedullary junction are reviewed and
presented, accompanied by case illustrations of each segment (or module) of
approach. The caudal portion of the midline anterior skull base and the
cervicomedullary junction is divided into modules of approach: the middle third
of the clivus, its lower third, and the cervicomedullary junction. Case
illustrations of successful resections of lesions via each module of the
approach are presented and discussed.
Conclusions
Endoscopic expanded
endonasal approaches to caudally located midline anterior skull base and
cervicomedullary lesions are feasible and hold great potential for decreased
morbidity. The effectiveness and appropriate use of these techniques must be
evaluated by close examination of outcomes as case series expand.