Critical Appraisal of Extent of Resection of Clival Lesions Using the Expanded Endoscopic Endonasal Approach

Abstract

Background: The expanded endoscopic endonasal approach has become a well-accepted technique for accessing clival lesions. Cadaveric anatomical studies have demonstrated the unobstructed view of the clivus and ventral brainstem that may be achieved with this approach. Critical neurovascular structures, primarily the paraclival internal carotid artery (ICA) segments, are generally considered to represent the lateral limits of safe exposure. To determine what true anatomic limitations exist using an endoscopic endonasal approach in patients with actual clival lesions, a detailed analysis of the postoperative imaging following resection of these lesions was performed.