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Extended Endoscopic Excision of Clival Based Lesions

Aric Park, Elie E. Rebeiz, MD, Carl Heilman, MD
Tufts Medical Center- Department of Otolaryngology, Boston, MA


PURPOSE OF STUDY
To review our experience with endoscopic endonasal approach for surgical management of clival tumors.

METHODS USED:
13 patients with clival tumors treated by endoscopic endonasal surgery between 11/9/97 and 10/2/05 were studied retrospectively. We will discuss the surgical technique.

SUMMARY OF RESULTS:
Most patients presented with diplopia (5) or headaches (4). There were 6 chordomas, 2 chondrosarcoma, 1 ossifying fibroma, 1 hamratomatous lipoma, 1 cholesterol granuloma, 1 lymphoma, and 1 metastatic Carcinoma. 8 patients had improvement in their presenting symptoms. 3 had no change. Length of stay varied from 1 to 5 days. Total tumor removal was performed in 9 cases, subtotal removal in 2 cases. Follow-up ranged from 3 to 48 months. Complications included 2 intraoperative cerebrospinal leaks which were repaired successfully during surgery, 1 episode of epistaxis, managed (how) 1 transient cranial nerve VI palsy that resolved spontaneously, and 1 nasal obstruction treated (how). There was no post operative bleeding, sinusitis or meningitis.

CONCLUSIONS:
Endoscopic endo-nasal surgery for clivus and anterior skull base lesions is a safe alternative to traditional open approaches and has several advantages including a low morbidity, quick recovery and limited complications. The use of endoscope to perform clival tumor surgery provides excellent visualization, but requires a learning curve and a team approach.

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