ArticleNeurosurgery practice2026
Clinical Outcome of Extended Endoscopic Endonasal Transclival Approach for Skull Base Lesions.
Article in Neurosurgery practice, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND AND
objectivesSurgical access to the clival region remains a significant challenge because of its midline location, deep anatomic position, and complex neurovascular relationships. The extended endoscopic endonasal approach (EEA) offers a direct, minimally invasive corridor to this intricate region of the skull base. This study presents a comprehensive review of the clinical presentation, surgical indications, and outcomes in a series of 46 patients who underwent EEA for lesions involving the clivus.
methodsThis was a retrospective study in which we identified cases of clival pathologies through our institution's skull base database from October 2014 and October 2024 based on our inclusion and exclusion criteria.
resultsSurgical indications included lesions at the craniovertebral junction, specifically craniovertebral junction instability requiring endonasal odontoidectomy in 15 patients (32.6%) and space-occupying lesions in the remaining 31 patients (67.4%). Among the latter, chordomas were the most common histopathological diagnosis. Clinical symptoms varied according to tumor location and underlying pathology. The extent of resection and the use of adjuvant radiotherapy were tailored to histopathological subtype. In patients with space-occupying lesions, gross total resection (GTR) was achieved in 46.7% of cases, while adjuvant radiotherapy was administered in 18 patients (38.1%). In cases of chordoma, GTR was more frequently achieved in smaller tumors (mean volume: 9.3 cm
conclusionBased on our experience, the EEA represents a safe and effective surgical option for clival lesions, with potential benefits including avoidance of craniotomy and brain retraction, reduced neurovascular manipulation, and lower surgical morbidity.
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