{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T00:18:59Z","timestamp":1790381939319,"version":"4.1.0"},"reference-count":19,"publisher":"Cambridge University Press (CUP)","issue":"5","license":[{"start":{"date-parts":[[2015,4,1]],"date-time":"2015-04-01T00:00:00Z","timestamp":1427846400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Laryngol. Otol."],"published-print":{"date-parts":[[2015,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0022215115000420_sec1\"><jats:title>Objective:<\/jats:title><jats:p>We wanted to present our experience with the extended endoscopic approach to clival pathology, focusing on cerebrospinal fluid leak and reconstruction challenges.<\/jats:p><\/jats:sec><jats:sec id=\"S0022215115000420_sec2\"><jats:title>Methods:<\/jats:title><jats:p>We examined a consecutive series of 37 patients undergoing the extended endoscopic approach for skull base tumours, 9 patients with clival pathology. Patients were examined for the incidence of post-operative cerebrospinal fluid leak in relation to tumour pathology, location, size, reconstruction and lumbar drain.<\/jats:p><\/jats:sec><jats:sec id=\"S0022215115000420_sec3\"><jats:title>Results:<\/jats:title><jats:p>The overall incidence of post-operative cerebrospinal fluid leak was 10.8 per cent. Seventy-five per cent of patients who had a post-operative cerebrospinal fluid leak underwent a transclival approach (<jats:italic>p<\/jats:italic> &lt; 0.05). All patients with clival pathology who underwent an intradural dissection had a post-operative cerebrospinal fluid leak (<jats:italic>p<\/jats:italic> &lt; 0.05).<\/jats:p><\/jats:sec><jats:sec id=\"S0022215115000420_sec4\"><jats:title>Conclusion:<\/jats:title><jats:p>Post-operative cerebrospinal fluid leak rates after the extended endoscopic approach have improved significantly after advancements including the vascularised nasoseptal flap. Despite this, transclival approaches continue to pose much difficulty. Further investigation is necessary to develop technical improvements that can meet the unique challenges associated with this region.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s0022215115000420","type":"journal-article","created":{"date-parts":[[2015,4,1]],"date-time":"2015-04-01T17:56:19Z","timestamp":1427910979000},"page":"468-472","source":"Crossref","is-referenced-by-count":12,"title":["Reconstructive challenges in the extended endoscopic transclival approach"],"prefix":"10.1017","volume":"129","author":[{"given":"A","family":"Kamat","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J Y K","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G H","family":"Goldstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J G","family":"Newman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P B","family":"Storm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J N","family":"Palmer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N D","family":"Adappa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2015,4,1]]},"reference":[{"key":"S0022215115000420_ref15","first-page":"198","article-title":"Endoscopic, endonasal, transclival resection of a pontine cavernoma: case report","volume":"71","author":"Sanborn","year":"2012","journal-title":"Neurosurgery"},{"key":"S0022215115000420_ref18","first-page":"212","article-title":"Neuronavigation using an image-guided endoscopic transnasal-sphenoethmoidal approach to clival chordomas","volume":"61","author":"Hwang","year":"2007","journal-title":"Neurosurgery"},{"key":"S0022215115000420_ref12","doi-asserted-by":"publisher","DOI":"10.1097\/MLG.0b013e31806db514"},{"key":"S0022215115000420_ref4","doi-asserted-by":"publisher","DOI":"10.3171\/2009.7.JNS081504"},{"key":"S0022215115000420_ref1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1012969719503"},{"key":"S0022215115000420_ref10","article-title":"Endoscopic reconstruction of the cranial base using a pedicled nasoseptal flap","volume":"63","author":"Kassam","year":"2008","journal-title":"Neurosurgery"},{"key":"S0022215115000420_ref6","article-title":"Endoscopic endonasal minimal access approach to the clivus: case series and technical nuances","volume":"67","author":"Fraser","year":"2010","journal-title":"Neurosurgery"},{"key":"S0022215115000420_ref14","doi-asserted-by":"publisher","DOI":"10.1159\/000343794"},{"key":"S0022215115000420_ref2","doi-asserted-by":"publisher","DOI":"10.3109\/02688697.2012.654837"},{"key":"S0022215115000420_ref13","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-2197.2011.05971.x"},{"key":"S0022215115000420_ref3","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2011.02.026"},{"key":"S0022215115000420_ref5","article-title":"The endoscopic transnasal transsphenoidal approach for the treatment of cranial base chordomas and chondrosarcomas","volume":"59","author":"Frank","year":"2006","journal-title":"Neurosurgery"},{"key":"S0022215115000420_ref7","doi-asserted-by":"publisher","DOI":"10.1227\/01.NEU.0000338071.01241.E2"},{"key":"S0022215115000420_ref8","doi-asserted-by":"publisher","DOI":"10.1227\/01.NEU.0000316414.20247.32"},{"key":"S0022215115000420_ref9","doi-asserted-by":"publisher","DOI":"10.1002\/lary.23351"},{"key":"S0022215115000420_ref16","doi-asserted-by":"publisher","DOI":"10.1016\/j.otc.2011.06.001"},{"key":"S0022215115000420_ref11","doi-asserted-by":"publisher","DOI":"10.1002\/lary.22475"},{"key":"S0022215115000420_ref17","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2011.09.005"},{"key":"S0022215115000420_ref19","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2009.11.031"}],"container-title":["The Journal of Laryngology &amp; 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