Neurosurgeon-otolaryngologist collaboration in endonasal approaches to the clivus and suprasellar region.

ABSTRACT

Lesions in the clivus and suprasellar region are rare but challenging pathologies for physicians. The most common tumours are chordomas and chondrosarcomas, but a wide variety of histopathological tumours can be found in these areas. Their deep location in the midline and their close relationship to important neurovascular structures frequently make total removal difficult. Neurosurgeons are often required to perform aggressive external-approach surgical therapy, which is usually associated with high levels of morbidity and a discouraging tendency for recurrence during long-term follow-up. Fortunately, over the past few years, close collaboration between otorhinolaryngologists and neurosurgeons has led to the development of minimally invasive surgery along the entire neuraxis, with endoscopy being used as the primary visualisation tool. This has been further augmented by the concept of team surgery ENT surgeons and neurosurgeons working simultaneously throughout all phases of the surgery (approach, resection, and reconstruction). This concept has also changed the surgical approach as a whole, making the endonasal route the main approach for treating these types of lesions in carefully selected patients and external approaches the second-place option. The endonasal approach has revolutionised skull base surgery as it enables less aggressive surgery (reaching deep-seated structures without the need for craniotomy and brain retraction). It is therefore associated with lower morbidity and an absence of visible scars, with encouraging initial oncological prognosis. The aims of this paper are to describe the anatomical landmarks for this approach, to relate our experiences and to provide a literature review.