Technical Notes on Endoscopic Transnasal Transsphenoidal Approach for Clival Chondrosarcoma

Atsushi Kuge,Yuki Saito,Takamasa Kayama,Sunao Takemura,Shinya Sato,Zensho Kikuchi,Kaori Sakurada

doi:10.1155/2011/953047

Abstract

Although there are various operative approaches for clival tumors, a transsphenoidal approach is one of choices when the main tumor extention is in an anterior-posterior direction with a slight lateral extension. However, this approach sometimes provides only narrow and deep operative field. Recently, endoscopic transnasal transsphenoidal approach is quite an effective approach for clival tumors because of the improvement of surgical instruments, image guidance systems, and techniques and materials of wound closure. In this paper, we describe the effectiveness, technical problems, and solution of this approach based on our experiences with two clival chondrosarcomas that was removed by endoscopic transnasal transsphenoidal approach.

Highlights

Clival chondrosarcomas are rare group that are thought to originate from primitive mesenchymal cells or from the embryonal portion of the cartilaginous matrix of the cranium
We describe the effectiveness, technical problems and solution of this approach based on our experiences with two clival chondrosarcomas that was removed by endoscopic transnasal transsphenoidal approach
We made suprasellar part of tumor remain intentionally, because suprasellar part was very hard, and we considered the possibility of the involvement of perforators and injury of hypothalamus

Summary

Introduction

Clival chondrosarcomas are rare group that are thought to originate from primitive mesenchymal cells or from the embryonal portion of the cartilaginous matrix of the cranium. These tumors have aggressive features, infiltrative neoplasms. An endoscopic transsphenoidal approach is quite an effective approach for clival tumors because of the improvement of surgical instruments, image guidance systems, and materials of wound closure such as fibrin glue. We describe the effectiveness, technical problems and solution of this approach based on our experiences with two clival chondrosarcomas that was removed by endoscopic transnasal transsphenoidal approach

Patients and Methods

Discussion