Endoscopic and microscopic extended subfrontal approach to the clivus: A comparative anatomical study

Pietro Mortini, Fabio Roberti, Chandrasekar Kalavakonda, Amal Nadel, Laligam N. Sekhar

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)139-146
Number of pages8
JournalSkull Base
Volume13
Issue number3
DOIs
Publication statusPublished - Aug 2003

Keywords

  • Anatomy
  • Clivus
  • Endoscopy
  • Microsurgery
  • Skull base

ASJC Scopus subject areas

  • Clinical Neurology

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