Endoscopic management of sphenoclival neoplasms: Anatomical correlates and patient outcomes
Presented as an oral presentation at Rhinology World 2009. Philadelphia, PA, April 15-19, 2009.
Received 9 August 2009; received in revised form 25 October 2009; accepted 19 November 2009.
Abstract
Objective
To characterize the endoscopic anatomy of the sphenoid sinus and the adjacent clivus and cavernous sinus, and to review patient outcomes for neoplasms in this region.
Study Design
Cadaver dissection and chart review.
Setting
Cadaver laboratory and tertiary care center.
Subjects and Methods
Fresh-frozen cadaver heads were dissected to study the endoscopic anatomy of the sphenoclival region. Retrospective chart review of patients undergoing endoscopic resection of sphenoclival neoplasms between 2000 and 2008 was performed.
Results
Transnasal endoscopic access to the sphenoid sinus was obtained in 10 cadaver heads. A clival window with mean dimensions of 1.4 cm × 1.7 cm was created. Through the clival window, identification and dissection of the basilar and vertebral arteries, mamillary bodies, third ventricle, cranial nerves III through VI, and cervical rootlets were possible. Nineteen patients with mean age of 56.2 years were treated. The most common pathologies were inverted papilloma (5), chordoma (4), squamous cell carcinoma (2), and adenoid cystic carcinoma (2). None of the patients required adjunct craniotomies. Nine patients received adjuvant therapies. Thirteen (68.4%) patients had no evidence of disease, five (26.3%) patients were alive with disease, and one (5.3%) patient died of disease at mean follow-up of 32.6 months.
Conclusion
The sphenoclival region poses a significant surgical challenge given its central location at the skull base and proximity to critical structures. This study demonstrates that transnasal endoscopic access to the sphenoclival region is technically feasible and allows successful surgical extirpation of tumors with a low complication rate and acceptable patient outcomes.
aDepartment of Otolaryngology–Head and Neck Surgery, Medical College of Georgia, Augusta, GA
bSchool of Medicine, Case Western Reserve University, Cleveland, OH
cDepartment of Otorhinolaryngology–Head and Neck Surgery, University of Texas Medical Center at Houston, Houston, TX
dPrivate Practice, Morristown Memorial Hospital, Morristown, NJ
eBrain Tumor Institute, Cleveland Clinic Foundation, Cleveland, OH
fDepartment of Otolaryngology–Head and Neck Surgery and Comprehensive Skull Base Program, University of Texas Southwestern Medical Center, Dallas, TX
Corresponding author: Pete S. Batra, MD, Comprehensive Skull Base Program and Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.
ABSTRACT