Microsurgical treatment for tumors of spheno-clival region by extended transsphenoidal approach

Objective To investigate the microsurgical treatment for tumors of spheno-clival region via extended transsphenoidal approach. Methods Clinical data of 25 patients suffering from spheno-clival tumours treated by extended transsphenoidal approach was analyzed retrospectively. Standard transseptal transsphenoidal approach was adopted to expose the sellar floor and dura mater, and the tumors were removed. Then, the projection of Hardy's speculum was modified to the clivus with the guidance of a fluoroscopic C-arm image. Under the assistance of frameless stereotactic guidance and endoscope, we used a high-speed drill to remove the clival bone for the exposure of the tumor. The resection should be stopped, once normal bone and dura mater appeared. Results Total removal of tumors was achieved in 21 cases (84%), and subtotal removal in 3 cases (12%), partial removal in 1 case (4%). Conclusion The extended transsphenoidal approach can provide the excellent exposure to the entire sphenoid sinus, sella turcia, and the upper clivus for resection of posterolateral or inferior extension of larger tumors involving the spheno-clival region. It has the advantages of low incidence of surgical complication and high total removal rate. Neuronavigation and endoscope may be helpful for this approach.