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Minim Invasive Neurosurg 2010; 53(5/06): 211-217
DOI: 10.1055/s-0030-1267929
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

The Transnasal Transclival Approach for Clivus Chordoma

D. Holzmann1 , R. Reisch2 , N. Krayenbühl2 , E. Hug3 , R. L. Bernays2
  • 1Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
  • 2Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
  • 3Center for Proton Therapy, Paul-Scherrer Institute, Villigen, Switzerland
Further Information

Publication History

Publication Date:
07 February 2011 (online)

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Abstract

Background: We present our experience using a standardized transnasal transclival approach (TTA) for endoscopic removal of chordomas of the clivus.

Patients: 13 patients with clival chordoma (CC) underwent tumor resection. Patients were operated by a surgical team consisting of a rhinosurgeon and a neurosurgeon. All patients underwent postoperative proton radiotherapy. Residual tumor was left in situations where radical removal would have entailed an increased risk of neurological deficits.

Results: Radical or near total removal of CC was accomplished in 12/13 patients. Intraoperative MRI (IMRI) was used in 4/13 CC patients. A watertight dural seal presented as the main challenge specifically for tumor extensions resulting in large dural defects.

Conclusion: The TTA provides an elegant alternative to classical approaches to clival lesions especially for midline tumor locations. For large tumors iMRI is of significant help. Dural reconstruction of large defects emerged as the greatest challenge of this technique even for experienced endoscopic surgeons.

Key words

endoscopic surgery - chordoma - skull base surgery - transsphenoidal surgery - intraoperative MRI - minimally invasive surgery

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Correspondence

D. HolzmannMD 

Department of Otorhinolaryngology

Head and Neck Surgery

University Hospital

CH-8091 Zurich

Switzerland

Phone: +41/44/255 5855

Fax: +41/44/255 45 56

Email: David.Holzmann@usz.ch

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