Endoscopic endonasal transclival resection of the upper clival meningioma.

OBJECTIVE In recent years, endoscope started to be used for the excision of the brainstem lesions or those localized in the anterior part of the brainstem. In this paper a case of clival meningioma resected through endoscopic endonasal transclival route has been presented with illustrations, live surgery videos demonstrating the surgery step by step. CASE REPORT A 35-year-old male patient consulted to us with dysphagia,and impaired consciousness. MR imaging detected a mass lesion with a wide base localized clivus and anterior part of brainstem. Following necessary preparations, the mass was resected through endoscopic endonasal transclival route Discussion: Presigmoid and lateral suboccipital approaches are the most popular methods for clival tumors However, its disadvantages are restricted surgical corridor when approaching to anterior lesions of the brainstem, and surgical manipulations which should be performed between cranial nerves so as to gain access into pathologic structures.The alternative endoscopic endonasal transclival method which is preferred so as to approach the lesion from the anterior aspect,does not have these disadvantages. CONCLUSION According to preoperative evaluation in meningiomas of the clival region if in meningioma located on retroclival area is suitable,for the use of endoscopic endonasal transclival route .In selected cases in parallel with advances in endoscopic technology, and surgical experience,we believe that in the future full endoscopic endonasal transclival approach will be an optimal alternative in the treatment of posterior system aneurysms, most of the extradural, and intradural lesions of the ventral aspect of the brainstem,and resistant cases causing vascular compression , and.