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Transclival approaches for intradural pathologies: historical overview and present scenario

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Abstract

Recently, endoscopic transsphenoidal transclival approaches have been developed and their role is widely accepted for extradural pathologies. Their application to intradural pathologies is still debated, but is undoubtedly increasing. In the past five decades, different authors have reported various extracranial, anterior transclival approaches for intradural pathologies. The aim of this review is to provide a historical overview of transclival approaches applied to intradural pathologies. PubMed was searched in October 2018 using the terms transcliv*, cliv* intradural, transsphenoidal transcliv*, transoral transcliv*, transcervical transcliv*, transsphenoidal brainstem, and transoral brainstem. Exclusion criteria included not reporting reconstruction technique, anatomical studies, reviews without new data, and transcranial approaches. Ninety-one studies were included in the systematic review. Since 1966, transcervical, transoral, transsphenoidal microsurgical, and, recently, endoscopic routes have been used as a corridor for transclival approaches to treat intradural pathologies. Each approach presents a curve that follows Scott’s parabola, with evident phases of enthusiasm that quickly faded, possibly due to high post-operative CSF leak rates and other complications. It is evident that the introduction of the endoscope has led to a significant increase in reports of transclival approaches for intradural pathologies. Various reconstruction techniques and materials have been used, although rates of CSF leak remain relatively high. Transclival approaches for intradural pathologies have a long history. We are now in a new era of interest, but achieving effective dural and skull base reconstruction must still be definitively addressed, possibly with the use of newly available technologies.

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Abbreviations

3D:

Three-dimensional

CSF:

Cerebrospinal fluid

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Funding

This study was funded by the Camillo Golgi Foundation.

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Authors and Affiliations

  1. Division of Neurosurgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy

    Francesco Belotti, Francesco Tengattini, Alberto Schreiber, Marco Maria Fontanella & Francesco Doglietto

  2. Division of Otorhinolaryngology - Head and Neck Surgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy

    Davide Mattavelli, Marco Ferrari, Alberto Schreiber & Piero Nicolai

  3. Department of Mechanical and Industrial Engineering, University of Brescia, Brescia, Italy

    Antonio Fiorentino, Silvia Agnelli & Alberto Schreiber

Authors
  1. Francesco Belotti
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  2. Francesco Tengattini
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  3. Davide Mattavelli
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  4. Marco Ferrari
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  5. Antonio Fiorentino
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  6. Silvia Agnelli
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  7. Alberto Schreiber
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  8. Piero Nicolai
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  9. Marco Maria Fontanella
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  10. Francesco Doglietto
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Correspondence to Francesco Doglietto.

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Belotti, F., Tengattini, F., Mattavelli, D. et al. Transclival approaches for intradural pathologies: historical overview and present scenario. Neurosurg Rev 44, 279–287 (2021). https://doi.org/10.1007/s10143-020-01263-w

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  • DOI: https://doi.org/10.1007/s10143-020-01263-w

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