Approaches to the Clivus: Approaches to No Man’s Land by Professor Dr. med. Prof. h.c. Madjid Samii, Professor Dr.

By Professor Dr. med. Prof. h.c. Madjid Samii, Professor Dr. med. Engelbert Knosp (auth.)

A special form of booklet! The clivus of cranium base is a space tricky to arrive in neurosurgery, otorhinolaryngolo- gy, maxillo-facial surgical procedure, cosmetic surgery, reconstructive surgical procedure, and orthopedic surgical procedure. it really is therefore that some of the specialities gave stumbled on assorted ways for various operations.

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If the tumor invades the dura or there are large intradural portions of tumor, we start by resection of the latter. When this has been completed, the dura must be sealed off watertight. Only then should the extradural tumor portions be attended to, or they should even be removed in a second-stage operation if prolonged surgery time, extensive loss of blood and other factors make this seem advisable. If a tumor involves the dura, it is often necessary to cover large dural defects. As the petiolated galaperiosteal flap has been prepared for covering the base adjacent to the paranasal sinuses, either fascia lata or a free galeaperiosteal flap taken from the posterior parietal scalp should be used for the dural defect itself; lyophilized dura may also be used.

The development of this approach was naturally founded on decades of experience in anterior skull base surgery (Unterberger 1958; Pertuiset 1955; Guiot and Derome 1966; Bonnal et al. 1961; Van Buren et al. 1968); it also comprises surgery of the orbit (Naffziger 1941; Brihaye et al. 1968; Schiirmann and Voth 1972) and has been further enhanced by the progress made by Tessier in the field of craniofacial surgery (Tessier 1973; Tessier et al. 1967, 1973). In 1972, Derome and associates presented a comprehensive description of sphenoethmoidal surgery and laid the foundation of the "transbasal" approach to the clivus (Derome 1972; Derome and Guiot 1979; Arita et al.

This goes particularly for tumors extending laterally. The lateral limits to resection are thus the major drawback 48 Transsphenoidai Approaches of this approach; removal of hard and compact tumors is extremely difficult this way. One of the great advantages, however, is that the approach does not put too much strain on the patient, so it is also suitable for high-risk patients in whom a trans cranial operation would be too hazardous and therefore contraindicated. Endocapsular tumor resection usually results in sufficient decompression of the brain stem.

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