Modifications of transnasal and transoral stereotactic procedures--technical notes

Stereotactic biopsy approach to the upper clivus through the middle fossa floor that avoids pneumatised cavities and the intradural compartment

BACKGROUND

Biopsies of clival lesions are usually performed, under general anaesthesia, through an anterior endoscopic approach or, alternatively, through a trans-nasal or trans-oral stereotactic approach.

METHODS

A 57-year-old man with a symptomatic osteolytical lesion of the clivus, who refused general anaesthesia, underwent a sterotactically guided biopsy of the lesion by an antero-lateral approach through the temporal and sphenoid bones.

RESULTS

Biopsy was successfully performed and the resulting diagnosis was myeloma. The patient was comfortable during and after surgery and there were no complications.

CONCLUSIONS

The present stereotactic antero-lateral approach to the biopsy of the upper clivus can be considered an useful adjunct to the current trans-oral and transnasal approaches that often require general anaesthesia.

Transoral stereotactic technique for clival biopsy

OBJECTIVE

To report a transoral freehand technique using continuous image guidance to biopsy a clival lesion.

METHODS

The patient was placed in a Mayfield head rest. Patient data were registered using preacquired magnetic resonance and computed tomography images, and then, under continuous image guidance, a bone biopsy instrument was advanced freehand through a transoral route into the clival lesion.

RESULTS

Bone biopsy instrumentation was successfully placed into the clival lesion. Biopsy forceps were placed through the working channel of the biopsy instrumentation and specimen was successfully retrieved from the clival mass. The patient tolerated the procedure well and the only complaint was dysphagia, which resolved in several days postoperatively.

CONCLUSION

The transoral freehand technique with stereotactic navigation was found to be a simple, safe, fast, and effective way to biopsy a clival lesion.

[Surgical anatomy of the nasal transphenoidal approach for pituitary tumors]

Different distances related to the nasal transphenoidal approach were measured on the hemiheads of eighteen cadavers in order to study its limits and advantages. The main mean measures obtained (mm) were: major diameter of the nostril 15.18: height of the nasal cavity 44.11, nostril-sella turcica distance 71.71. These results show that the nasal approach is wide and direct to the sella turcica. The present study demonstrate the possibility of preservation of the cartilaginous septum and other structures which are usually damaged when the sublabial approach is employed.