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Chapter-59 Endoscopic Surgery of the Clivus, Craniocervical Junction, and Posterior Fossa

BOOK TITLE: Sataloff’s Comprehensive Textbook of Otolaryngology: Head & Neck Surgery (Rhinology/Allergy and Immunology) -Volume 2

Author
1. Stamm Aldo Cassol
2. Hermann Diego Rodrigo
3. Balsalobre Leonardo
4. Vellutini Eduardo de Arnaldo Silva
ISBN
9789351524564
DOI
10.5005/jp/books/12714_60
Edition
1/e
Publishing Year
2016
Pages
10
Author Affiliations
1. Hospital Professor Edmundo Vasconcelos, Sao Paulo, Sao Paulo, Brazil
2. Centro de Otorrinolaringologia de São Paulo, São Paulo, São Paulo, Brazil
3. Complexo Hospitalar Edmundo Vasconcelos, São Paulo, São Paulo, Brazil
4. DFV Neuro, São Paulo, São Paulo, Brazil
Chapter keywords
malignant tumors, basiocciput, nasopharynx, jugular foramen, magnetic resonance angiography, occipital condyles, hypoglossal canal, pontomedullary junction, sphenopetroclival area, functional integrity, lumbar drains, hemitransfixion septal incision, mucosal flap, monopolar diathermy needle, ultrasonic suction, surgical dissection

Abstract

This chapter discusses endoscopic surgery of the clivus, craniocervical junction, and posterior fossa, where the clivus is actually a bony region formed by the posterior portion of the sphenoid body and the basilar part of the occipital bone. The neural structures situated at clivus level are caudal part of the brainstem, cerebellum, fourth ventricle, the rostral part of the spinal cord, and the lower cranial and upper cervical nerves. Skull base surgery requires precise and gentle maneuvers and in order to achieve good results with low morbidity rates, the use of proper instruments is indispensable. Surgery is usually carried out under hypotensive general anesthesia. To reduce bleeding from the free edges of the mucosal flap and remaining in situ mucosa, the incision is made with the use of a monopolar diathermy needle. The use of prophylactic antibiotics may help to reduce crust formation, improve healing, and decrease the chance of infectious complications.

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