Abstract
The endoscopic endonasal transclival approach has been widely described for its use to resect clivus chordomas, but there have only been isolated reports of its use for petroclival meningiomas. These tumors are most often resected utilizing open transpetrosal approaches, but these operations, difficult even in the hands of dedicated skull base surgeons, are particularly challenging if the meningiomas are medially-situated and positioned mainly behind the clivus. For this subset of petroclival meningiomas, a transclival approach may be preferable. We report a meningioma resected via an endoscopic endonasal transclival technique. The patient was a 63-year-old man who presented originally for medical attention because of diplopia related to an abducens palsy on the left. A workup at that time revealed a meningioma contained entirely in the left cavernous sinus, and this was treated with stereotactic radiosurgery. His symptoms resolved and his meningioma was stable on MRI for several years after treatment. The patient was then lost to follow-up until 13 years after radiosurgery when he experienced intermittent diplopia again. At this point, workup revealed a large petroclival meningioma compressing the brainstem. He underwent a successful endoscopic endonasal transclival resection of this tumor. A demonstration of the step-by-step surgical technique, discussion of the nuances of the operation, and a comparison with the open transpetrosal approaches are included in our report.
Highlights
The transpetrosal approaches have been long considered the most favored, if not “standard”, approach for resecting tumors of the petroclival region [1]
The endoscopic endonasal transclival approach has been widely described for its use to resect clivus chordomas, but there have only been isolated reports of its use for petroclival meningiomas
We report a meningioma resected via an endoscopic endonasal transclival technique
Summary
The transpetrosal approaches have been long considered the most favored, if not “standard”, approach for resecting tumors of the petroclival region [1]. Ever since it first appeared in the literature in 2005, the endoscopic endonasal transclival approach has significantly impacted the discourse on this topic [2]. We aim to add to the body of evidence that supports the use of the endoscopic endonasal approach for these difficult meningiomas as well as to provide the first video demonstration of this technique. How to cite this article Jean W C, Felbaum D R, Anaizi A, et al (June 14, 2016) Endoscopic Endonasal Approach for Transclival Resection of a Petroclival Meningioma: A Technical Note.
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