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Skull Base 2003; 13(3): 139-148
DOI: 10.1055/s-2003-43324
ORIGINAL ARTICLE

Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Endoscopic and Microscopic Extended Subfrontal Approach to the Clivus: A Comparative Anatomical Study

Pietro Mortini1 , Fabio Roberti2 , Chandrasekar Kalavakonda2 , Amal Nadel,2 , Laligam N. Sekhar3
  • 1Department of Neurosurgery, University “Vita e Salute,” San Raffaele Hospital, Milan, Italy
  • 2Department of Neurosurgery, The George Washington University, Washington, D.C
  • 3The Mid-Atlantic Brain and Spine Institutes, Annandale, Virginia
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Publication History

Publication Date:
18 May 2004 (online)

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ABSTRACT

Ten cadaveric heads fixed and injected were dissected in the operative position. An enlarged subfrontal approach was adopted. The clival bone was drilled as much as possible under direct microscopic vision. Dissection in blind angles was avoided until the clival dura was exposed. The rigid 4-mm endoscope (angled 0 degrees and 30 degrees) was secured in a holder so the surgical cavity could be inspected. The residual bone was drilled under endoscopic visualization. The amount of bone removed was measured and compared with that removed under microscopic view. Blind angles in both microscopic and endoscopic views were recorded. The additional area of clival bone removed under endoscopic visualization compared with microscopic visualization was 467 mm2 (range, 176 to 753 mm2; standard deviation, 208.8 mm2).The amount of additional bone removed under endoscopy was inversely and significantly related to the minimal distance between the vertical segment of the two cavernous carotid arteries (p = 0.04). The endoscope is of great value in the removal of clival bone through the extended subfrontal approach. Its use improves the visualization of angles that are blind under the microscope.

KEYWORDS

Anatomy - clivus - endoscopy - microsurgery - skull base

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