{"id":"7cef2442-83e5-4285-ba37-41386b3b9a03","slug":"endoscopic-endonasal-approach-for-the-resection-of-a-clival-meningioma-two-dimensional-operative-video","title":"Endoscopic endonasal approach for the resection of a clival meningioma: Two-dimensional operative video","authors":["Marco Antonio Munuzuri-Camacho","Marcos V. Sangrador-Deitos","Jorge Alanis-Mendizabal","Luis Alberto Rodriguez-Hernandez","J. Tomas Moncada-Habib","Victor Alcocer-Barradas"],"abstract":"Background: The endoscopic endonasal approach for the resection of clival meningiomas involves navigating through the nasal cavity and sphenoid sinus to access the clivus. This minimally invasive technique provides enhanced visualization and precision, allowing for effective tumor resection while minimizing damage to surrounding structures and shortening recovery time. Case Description: We present the case of a 43-year-old male who experienced intermittent headaches and dysphagia. Neurological examination revealed right-sided hemiparesis and abolition of the gag reflex. An initial computed tomography scan identified hydrocephalus, which was managed with a ventriculoperitoneal shunt. Subsequent magnetic resonance imaging demonstrated a well-defined extra-axial lesion at the clivus with homogeneous contrast enhancement, a dural tail extending toward the clivus, and brainstem displacement, suggestive of a clival meningioma. Given the tumor’s location and characteristics, a minimally invasive endoscopic approach was selected as the preferred surgical strategy. This technique provides several advantages over traditional transcranial methods, including direct tumor visualization, preservation of glandular function, reduced cranial nerve manipulation, and improved control of the posterior fossa’s vascular structures. Conclusion: Although the endoscopic endonasal approach offers significant benefits in clival meningioma resection, it requires specialized training to optimize outcomes and minimize complications. This video abstract aims to provide a step-by-step guide to the endonasal corridor leading to the clival region, emphasizing key vascular structures and the transposition of the pituitary gland to facilitate safe and effective tumor removal. 00:09 Clinical presentation 00:32 Neuroimaging findings 01:04 Rationale for the procedure 01:20 Risk and benefits 02:28 Description of the setup 03:13 Pedicled nasoseptal flap grafting 03:33 Identification of osseus landmarks 03:38 Resection of sellar floor 03:59 Exposure of right cavernous sinus and paraclival ICA 04:25 Opening of the anterior wall of the cavernous sinus 04:58 Identification of the inferior hypophyseal artery 05:09 Interdural pituitary transposition 05:20 Bilateral posterior clinoidectomy 05:43 Tumor identification 06:22 Progressive debulking and dissection from neurovascular structures 07:42 Multilayered reconstruction 07:59 Disease background The Institutional Review Board approval is not required. The authors certify that they have obtained all appropriate patient consent. There are no conflicts of interest. The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI. https://doi.org/10.25259/SNI_276_2025 The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/placeholders/specialty/skull-base.png","publishDate":"2025-06-06T00:00:00.000Z","doi":"10.25259/SNI_276_2025","categories":["Skull Base","Video Abstract"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/7cef2442-83e5-4285-ba37-41386b3b9a03/pdf"}