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- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Tlalpan, Mexico
- Department of Neurosurgery, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
Correspondence Address:
Victor Alcocer-Barradas, Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Tlalpan, Mexico.
DOI:10.25259/SNI_276_2025
Copyright: © 2025 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.How to cite this article: Marco Antonio Munuzuri-Camacho1, Marcos V. Sangrador-Deitos2, Jorge Alanis-Mendizabal1, Luis Alberto Rodriguez-Hernandez1, J. Tomas Moncada-Habib1, Victor Alcocer-Barradas1. Endoscopic endonasal approach for the resection of a clival meningioma: Two-dimensional operative video. 06-Jun-2025;16:230
How to cite this URL: Marco Antonio Munuzuri-Camacho1, Marcos V. Sangrador-Deitos2, Jorge Alanis-Mendizabal1, Luis Alberto Rodriguez-Hernandez1, J. Tomas Moncada-Habib1, Victor Alcocer-Barradas1. Endoscopic endonasal approach for the resection of a clival meningioma: Two-dimensional operative video. 06-Jun-2025;16:230. Available from: https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=13609
Date of Submission
18-Mar-2025
Date of Acceptance
13-May-2025
Date of Web Publication
06-Jun-2025
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.
Keywords: Clival meningioma, Endoscopic surgery, Minimally invasive techniques, Skull base tumors, Transnasal approach, Tumor resection
Video 1
Annotations[1-3]
00:09 Clinical presentation 00:32 Neuroimaging findings 01:04 Rationale for the procedure 01:20 Risk and benefits 02:00 Alternatives 02:28 Description of the setup 03:13 Pedicled nasoseptal flap grafting 03:30 Sphenoidotomy 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 08:06 Outcome.
Ethical approval:
The Institutional Review Board approval is not required.
Declaration of patient consent:
The authors certify that they have obtained all appropriate patient consent.
Financial support and sponsorship:
Nil.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
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.
Video available on:
Disclaimer
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.
References
1. Butenschoen VM, Krauss P, Bernhardt D, Negwer C, Combs S, Meyer B. The transnasal endoscopic approach for resection of clival tumors: A single-center experience. Sci Rep. 2023. 13: 3012
2. James J, Irace AL, Gudis DA, Overdevest JB. Simulation training in endoscopic skull base surgery: A scoping review. World J Otorhinolaryngol Head Neck Surg. 2022. 8: 73-81
3. Mastantuoni C, Cavallo LM, Esposito F, D’Avella E, De Divitiis O, Somma T. Midline skull base meningiomas: Transcranial and endonasal perspectives. Cancers (Basel). 2022. 14: 2878
