Article
Endoscopic (3D) endonasal transsphenoidal, tranclival approach for a large clival meningioma: case report with complication management
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Authors
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Francesco Doglietto
- Divisions of Neurosurgery
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Andrea Bolzoni Villaret
- ENT surgery and
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Marco Ravanelli
- Radiology, University of Brescia, Italy
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Roberto Maroldi
- Radiology, University of Brescia, Italy
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Piero Nicolai
- ENT surgery and
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Marco Maria Fontanella
- Divisions of Neurosurgery
| Published: | June 2, 2015 |
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Outline
Text
Objective: The surgical management of intradural clival tumours is difficult due to the relative inaccessibility of the clivus through traditional neurosurgical approaches, and the intimate relationship of such tumours to critical neurovascular and brainstem structures.
Method: Aim of this report is to describe in detail the excision of a large clival meningioma with an endoscopic (3D) endonasal transsphenoidal, tranclival approach.
Results: A 68-year-old woman with a three-year history of diplopia and recent atypical right trigeminal neuralgia was diagnosed a large clival meningioma, with marked brainstem compression. After clinical and radiological evaluation, we opted for a pure endonasal endoscopic transsphenoidal approach. Pre-operative angiography documented an ascending pharyngeal artery as the main tumor feeder, which was coagulated at the first surgical stage, which included a complete clivectomy. The second stage comprised dural opening, tumor debulking and removal, dural and clival reconstruction. One week after surgery, due to the evidence of a CSF leak, the patient underwent a new clival reconstruction by means of fascia lata, ear cartilage and temporo-parietal flap. She was discharged without any new neurological deficit.
Conclusions: The endoscopic endonasal transsphenoidal transclival approach has the benefit of a direct approach to clival meningiomas; its main limitation is the skull base reconstruction. In this video session, all steps of the procedure will be presented, including the management of a CSF leak due to failure of the naso-septal flap.
