Artikel
Transnasal endoscopic surgery of clival pathologies – a case series of 51 patients and introduction of a new extent classification
Transnasale endoskopische Versorgung von Clivuspathologien – eine konsekutive Fallserie von 51 Patienten und Vorstellung einer neuen Ausdehnungsklassifikation
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Veröffentlicht: | 4. Juni 2021 |
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Gliederung
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Objective: Clival pathologies present challenging entities regarding their treatment options. Due to their close proximity to critical neurovascular structures, the operative goal of gross total resection is rendered more difficult with a high risk of neurological deficits.
Methods: We performed a retrospective cohort study of all consecutive patients treated through a transnasal endoscopic approach between 2009 and 2020. Clival tumors were classified depending on their extension (CE1-4), and tumor extension, preoperative clinical status, surgery duration and preoperative radiotherapy were considered prognostic factors.
Results: In total, 68 transnasal endoscopic surgeries were performed in 51 patients over a time period of 12 years. Most lesions were clival chordomas, 66.7% of the lesions did not reach the brainstem (classified extent CE1 and CE2). Cranial nerve impairment was present in 56.9% of the patients, 60% remained clinically stable after surgery, 60% of the patients with cranial nerve palsy improved after surgical treatment. Interrater reliability for tumor extension classification showed a perfect agreement (Cohen’s Kappa= 0.807).
Conclusion: Clival pathologies exhibit heterogenous characteristics. Depending on tumor extension, the patient should be advised regarding his postoperative outcome and the probability of single- vs. multi-staged approaches.