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The first 25 slides, exactly as they appear. The full deck has 44 content slides.
Neurosurgery
Transmaxillary Approaches to the Clivus
Built from Feldman — Neurosurgical Operative Atlas: Neuro-Oncology
What’s inside
6 sections · 44 slides
Overview
- First, what and where is the clivus?
- Why the clivus is so hard to operate on
- The transmaxillary toolkit at a glance
Anatomy of the clivus
The three-dimensional bony landmark the whole operation is built around
- What the clivus is made of
- Upper clivus versus lower clivus
Preoperative evaluation
Planning, imaging, and preparation before the first incision
- Imaging: CT and MRI together
- When angiography and endovascular help are added
- Dental evaluation: why the teeth matter
- Medical readiness and positioning
- Protecting the eyes and the airway
- CSF drainage, antibiotics, and steroids
Open transmaxillary approaches
Choosing incisions and bone cuts to swing the face open and see the clivus
- A menu of incisions and osteotomies
- Lateral rhinotomy with medial maxillectomy
- Lateral rhinotomy incision on the face
- LeFort I osteotomy: exposure without a facial scar
- LeFort I: making the cuts and dropping the maxilla
- LeFort I: closing back up
- LeFort I osteotomy, step by step
- Maxillotomy (maxillary swing): the widest open exposure
- Maxillary swing: opening and closing
- Maxillotomy exposure of the clivus
- Labiomandibular glossotomy: a route from below
- Labiomandibular glossotomy with palatal split
- Combining approaches for more reach
- Matching the open approach to the target
Endoscopic approaches to the clivus
Reaching the same target through the nose, with a camera instead of a facial incision
- Why the endoscope works here
- Instrumentation: seeing and steering safely
- Surgical exposure through the nose
- Reconstruction: sealing the skull base
Postoperative care and complications
Recovery, and the specific problems this deep midline surgery can cause
- Postoperative care
- CSF leak: the signature complication
- Pneumocephalus: air trapped in the head
- Infection-related complications
- Swallowing and healing complications
- Serous otitis media and eustachian tube dysfunction
- Why is reconstruction after an endoscopic transclival tumor resection so demanding?
- Take-home messages
- Neurosurgical Operative Atlas: Neuro-Oncology