{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T18:10:26Z","timestamp":1789841426492,"version":"4.0.1"},"reference-count":61,"publisher":"Georg Thieme Verlag KG","issue":"05","funder":[{"name":"Charles B. and Ann L. Johnson Endowed Professorship in Neurosurgery"},{"name":"Joseph I. and Barbara Ashkins Endowed Professorship in Neurosurgery"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurol Surg B Skull Base"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Introduction\u2003The clival, paraclival, and craniocervical junction regions are challenging surgical targets. To approach these areas, endoscopic endonasal transclival approaches (EETCAs) and their extensions (far-medial approach and odontoidectomy) have gained popularity as they obviate manipulating and working between neurovascular structures. Although several cadaveric studies have further refined these contemporary approaches, few provide a detailed step-by-step description. Thus, we aim to didactically describe the steps of the EETCAs and their extensions for trainees.<\/jats:p><jats:p>\n          Methods\u2003Six formalin-fixed cadaveric head specimens were dissected. All specimens were latex-injected using a six-vessel technique. Endoscopic endonasal middle and inferior clivectomies, far-medial approaches, and odontoidectomy were performed.<\/jats:p><jats:p>\n          Results\u2003Using angled endoscopes and surgical instruments, an endoscopic endonasal midclivectomy and partial inferior clivectomy were performed without nasopharyngeal tissue disruption. To complete the inferior clivectomy, far-medial approach, and partially remove the anterior arch of C1 and odontoid process, anteroinferior transposition of the Eustachian\u2013nasopharynx complex was required by transecting pterygosphenoidal fissure tissue, but incision in the nasopharynx was not necessary. Full exposure of the craniocervical junction necessitated bilateral sharp incision and additional inferior mobilization of the posterior nasopharynx. Unobstructed access to neurovascular anatomy of the ventral posterior fossa and craniocervical junction was provided.<\/jats:p><jats:p>\n          Conclusion\u2003EETCAs are a powerful tool for the skull-base surgeon as they offer a direct corridor to the ventral posterior fossa and craniocervical junction unobstructed by eloquent neurovasculature. To facilitate easier understanding of the EETCAs and their extensions for trainees, we described the anatomy and surgical nuances in a didactic and step-by-step fashion.<\/jats:p>","DOI":"10.1055\/a-2114-4660","type":"journal-article","created":{"date-parts":[[2023,6,22]],"date-time":"2023-06-22T05:38:58Z","timestamp":1687412338000},"page":"526-539","source":"Crossref","is-referenced-by-count":2,"title":["Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Endoscopic Endonasal Middle-Inferior Clivectomy, Odontoidectomy, and Far-Medial Approach"],"prefix":"10.1055","volume":"85","author":[{"given":"Edoardo","family":"Agosti","sequence":"additional","affiliation":[{"name":"Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States"},{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States"},{"name":"Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. Yohan","family":"Alexander","sequence":"additional","affiliation":[{"name":"Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States"},{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luciano C. P. C.","family":"Leonel","sequence":"additional","affiliation":[{"name":"Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States"},{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8087-7870","authenticated-orcid":false,"given":"Jamie J. Van","family":"Gompel","sequence":"additional","affiliation":[{"name":"Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States"},{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States"},{"name":"Department of Otolaryngology\/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Link","sequence":"additional","affiliation":[{"name":"Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States"},{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States"},{"name":"Department of Otolaryngology\/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garret","family":"Choby","sequence":"additional","affiliation":[{"name":"Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States"},{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States"},{"name":"Department of Otolaryngology\/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos D.","family":"Pinheiro-Neto","sequence":"additional","affiliation":[{"name":"Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States"},{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States"},{"name":"Department of Otolaryngology\/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Peris-Celda","sequence":"additional","affiliation":[{"name":"Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States"},{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States"},{"name":"Department of Otolaryngology\/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2023,8,2]]},"reference":[{"issue":"05","key":"ref1","doi-asserted-by":"crossref","first-page":"1454","DOI":"10.3171\/2016.12.JNS161920","article-title":"Clinical outcomes of an endoscopic transclival and transpetrosal approach for primary skull base malignancies involving the clivus","volume":"128","author":"Y H Kim","year":"2018","journal-title":"J Neurosurg"},{"issue":"04","key":"ref2","doi-asserted-by":"crossref","first-page":"5","DOI":"10.17116\/neiro20178145-16","article-title":"Extended endoscopic endonasal posterior (transclival) approach to tumors of the clival region and ventral posterior cranial fossa. 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Topographic and anatomical features of the clivus and adjacent structures [in Russian]","volume":"81","author":"A N Shkarubo","year":"2017","journal-title":"Vopr Neirokhir"},{"issue":"03","key":"ref3","doi-asserted-by":"crossref","first-page":"S93","DOI":"10.1097\/00006123-200009001-00013","article-title":"The cerebellopontine angle and posterior fossa cranial nerves by the retrosigmoid approach","volume":"47","author":"A L Rhoton Jr","year":"2000","journal-title":"Neurosurgery"},{"issue":"05","key":"ref4","doi-asserted-by":"crossref","first-page":"783","DOI":"10.3171\/JNS\/2008\/109\/11\/0783","article-title":"Anterior clivectomy: surgical technique and clinical applications","volume":"109","author":"O Al-Mefty","year":"2008","journal-title":"J Neurosurg"},{"issue":"06","key":"ref5","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1002\/hed.23415","article-title":"Clival chordomas: a pathological, surgical, and radiotherapeutic review","volume":"36","author":"J C Fernandez-Miranda","year":"2014","journal-title":"Head Neck"},{"issue":"01","key":"ref6","doi-asserted-by":"crossref","first-page":"E6","DOI":"10.3171\/foc.2005.19.1.7","article-title":"Expanded endonasal approach: fully endoscopic, completely transnasal approach to the middle third of the clivus, petrous bone, middle cranial fossa, and infratemporal fossa","volume":"19","author":"A B Kassam","year":"2005","journal-title":"Neurosurg Focus"},{"issue":"03","key":"ref7","doi-asserted-by":"crossref","first-page":"322","DOI":"10.23736\/S0390-5616.18.04411-9","article-title":"The limits of the endoscopic endonasal transclival approach for posterior fossa tumors","volume":"62","author":"A Bossi Todeschini","year":"2018","journal-title":"J Neurosurg Sci"},{"key":"ref8","first-page":"ONS50","article-title":"The endoscopic transnasal transsphenoidal approach for the treatment of cranial base chordomas and chondrosarcomas","volume":"59","author":"G Frank","year":"2006","journal-title":"Neurosurgery"},{"issue":"05","key":"ref9","doi-asserted-by":"crossref","first-page":"17","DOI":"10.17116\/neiro201781517-30","article-title":"Extended endoscopic endonasal posterior (transclival) approach to tumors of the clival region and ventral posterior cranial fossa. 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