Endoscopic versus Open Clival Chordoma Resection: A Systematic Review

Abstract

Objective: Microscope-based surgical approaches to the clivus require large openings to allow the passage of sufficient light to the lateral extent of clival chordomas, and have traditionally utilized extensive bone drilling, brain retraction, and manipulation of cranial nerves that lie along the operative trajectory. A ventral approach to the tumor is a more logical trajectory, but transoral approaches are limited by the hard palate, and transfacial approaches may be cosmetically undesirable. The endoscopic transclival approach represents a new paradigm in surgical philosophy, offering a minimal access, maximally aggressive alternative that may be preferable in a subgroup of patients. We performed a systematic analysis of the literature to assess the efficacy and complications of this approach compared with more standard cranial base approaches.