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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

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Endoscopic endonasal extradural posterior clinoidectomy for skull base tumour

Endoskopische endonasale extradurale posteriore Clinoidektomie bei Schädelbasistumor

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  • presenting/speaker Hiroki Ohata - Osaka City University, Neurosurgery, Osaka, Japan
  • Takeo Goto - Osaka City University, Neurosurgery, Osaka, Japan
  • Alhusain Nagm - Osaka City University, Neurosurgery, Osaka, Japan
  • Narasinga Rao - Philipps-Universität Marburg, Neurosurgery, Bengaluru, India
  • Kosuke Nakajo - Osaka City University, Neurosurgery, Osaka, Japan
  • Hiroki Morisako - Osaka City University, Neurosurgery, Osaka, Japan
  • Hiroyuki Goto - Osaka City University, Neurosurgery, Osaka, Japan
  • Takehiro Uda - Osaka City University, Neurosurgery, Osaka, Japan
  • Shinichi Kawahara - Osaka City University, Neurosurgery, Osaka, Japan
  • presenting/speaker Kenji Ohata - Osaka City University, Neurosurgery, Osaka, Japan

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocJM-JNS04

doi: 10.3205/20dgnc210, urn:nbn:de:0183-20dgnc2106

Published: June 26, 2020

© 2020 Ohata et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: The endoscopic endonasal approach for skull base tumors has become an important topic in recent years, but its use, merits, and demerits are still being debated. The objective of this study was to describe the surgical implementation and efficacy of the endoscopic endonasal extradural posterior clinoidectomy to obtain maximal tumor exposure.

Methods: The surgical technique included extradural posterior clinoidectomy following lateral retraction of the internal carotid artery at the paraclival segment and extradural pituitary retraction. In cases with prominent posterior clinoid process, the sellar dura was cut midline to facilitate extradural exposure of the process. Forty-four consecutive patients in whom this technique was performed between 2016 and 2018 at the authors’ institution were reviewed. The pathology included 19 craniopharyngiomas, 7 chordomas, 6 meningiomas, 6 pituitary adenomas, 4 chondrosarcomas, and 2 miscellaneous. Utilization and effectiveness of this approach were further demonstrated with the radiological study of clinical cases.

Results: All cases were successfully operated using this procedure without any neurovascular injury, and it facilitated greater resection of the tumors. Four patients experienced transient postoperative abducens nerve paresis, and one patient experienced transient postoperative oculomotor nerve paresis; however, the deficits recovered within 3 months. On radiological examination, the surgical field was 2.2 times wider in cases with bilateral posterior clinoidectomy than in cases without posterior clinoidectomy.

Conclusion: The endoscopic endonasal approach with posterior clinoidectomy increases the working space and the maneuverability of the instruments to remove the tumor extended behind the posterior clinoid and dorsum sellae.