Quantitative anatomical comparison of transnasal and transcranial approaches to the clivus.
Acta Neurochir (Wien)
; 162(3): 649-660, 2020 03.
Article
en En
| MEDLINE
| ID: mdl-31792688
ABSTRACT
BACKGROUND AND OBJECTIVE:
The clivus was defined as "no man's land" in the early 1990s, but since then, multiple approaches have been described to access it. This study is aimed at quantitatively comparing endoscopic transnasal and microsurgical transcranial approaches to the clivus in a preclinical setting, using a recently developed research method.METHODS:
Multiple approaches were performed in 5 head and neck specimens that underwent high-resolution computed tomography (CT) endoscopic transnasal (transclival, with hypophysiopexy and with far-medial extension), microsurgical anterolateral (supraorbital, mini-pterional, pterional, pterional transzygomatic, fronto-temporal-orbito-zygomatic), lateral (subtemporal and subtemporal transzygomatic), and posterolateral (retrosigmoid, far-lateral, retrolabyrinthine, translabyrinthine, and transcochlear). An optic neuronavigation system and dedicated software were used to quantify the working volume of each approach and calculate the exposure of different clival regions. Mixed linear models with random intersections were used for statistical analyses.RESULTS:
Endoscopic transnasal approaches showed higher working volume and larger exposure compared with microsurgical transcranial approaches. Increased exposure of the upper clivus was achieved by the transnasal endoscopic transclival approach with intradural hypophysiopexy. Anterolateral microsurgical transcranial approaches provided a direct route to the anterior surface of the posterior clinoid process. The transnasal endoscopic approach with far-medial extension ensured a statistically larger exposure of jugular tubercles as compared with other approaches. Presigmoid approaches provided a relatively limited exposure of the ipsilateral clivus, which increased in proportion to their invasiveness.CONCLUSIONS:
This is the first anatomical study that quantitatively compares in a holistic way exposure and working volumes offered by the most used modern approaches to the clivus.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Fosa Craneal Posterior
/
Neuronavegación
/
Cirugía Endoscópica por Orificios Naturales
/
Microcirugia
Límite:
Humans
Idioma:
En
Revista:
Acta Neurochir (Wien)
Año:
2020
Tipo del documento:
Article
País de afiliación:
Italia