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The first 25 slides, exactly as they appear. The full deck has 53 content slides.
Neurosurgery
Surgical Resection of Clival Tumors
Built from Feldman — Neurosurgical Operative Atlas: Neuro-Oncology
What’s inside
9 sections · 53 slides
Overview
- What this talk will teach you
The clivus and its tumors
What we are dealing with and why it is difficult
- Where is the clivus?
- Why clival tumors are so challenging
- Three ways tumors involve the clivus
- How patients present
- Upper- to midclival chordoma on MRI
Choosing the surgical corridor
Letting the tumor's anatomy pick the route
- The guiding principle
- Matching the tumor location to the approach
- Front door versus side door
- Anatomy reached by the extended endonasal approach
Getting ready for surgery
Imaging, antibiotics, positioning, and monitoring
- Imaging and the road map
- Antibiotics, tubes, and the sterile field
- Neuromonitoring, tailored to the route
- The lumbar drain: helpful but handled with care
The endoscopic endonasal approach
Operating on the clivus through the nostrils
- Positioning for a clival approach
- The nasal phase and saving the repair flap
- Widening the corridor and removing bone
- Respecting the arteries and nerves
- LeFort I transmaxillary transpterygoid exposure
- Reaching sideways: the transpterygoid extension
- Transpterygoid route to a clival chondrosarcoma
- Rebuilding the skull base
- The button graft and backup flaps
Transtemporal approaches
Reaching lateral and petroclival disease from the side
- When and how the side route is used
- Three posterior petrosal corridors
- What decides which transtemporal route
- Infratemporal fossa chondrosarcoma resection
The transcondylar approach
Reaching the lower clivus and foramen magnum
- When the lower route is chosen
- Positioning and opening up
- Step-by-step transcondylar fossa approach
- Finding the artery and removing bone
- Vertebral artery mobilized in chordoma resection
- The intradural stage
- Intradural tumor and lower cranial nerves
- Closing and combining approaches
- Staged transcondylar plus endonasal resection
After surgery
Recovery, complications, and adjuvant therapy
- The early recovery
- Complications and how they are managed
- Adjuvant therapy after resection, by pathology
Summary
The key messages to carry away
- Key takeaways
- Why is the endoscopic endonasal route preferred for a midline upper-clival tumor that pushes the carotids laterally?
- References (1/2)
- References (2/2)
- Neurosurgical Operative Atlas: Neuro-Oncology