BACKGROUND AND OBJECTIVE The clivus was defined as "no man's land" in the early 1990s, but since then, multiple approaches have been described to access it. This study is aimed at quantitatively comparing endoscopic transnasal and microsurgical transcranial approaches to the clivus in a preclinical setting, using a recently developed research method. METHODS Multiple approaches were performed in 5 head and neck specimens that underwent high-resolution computed tomography (CT): endoscopic transnasal (transclival, with hypophysiopexy and with far-medial extension), microsurgical anterolateral (supraorbital, mini-pterional, pterional, pterional transzygomatic, fronto-temporal-orbito-zygomatic), lateral (subtemporal and subtemporal transzygomatic), and posterolateral (retrosigmoid, far-lateral, retrolabyrinthine, translabyrinthine, and transcochlear). An optic neuronavigation system and dedicated software were used to quantify the working volume of each approach and calculate the exposure of different clival regions. Mixed linear models with random intersections were used for statistical analyses. RESULTS Endoscopic transnasal approaches showed higher working volume and larger exposure compared with microsurgical transcranial approaches. Increased exposure of the upper clivus was achieved by the transnasal endoscopic transclival approach with intradural hypophysiopexy. Anterolateral microsurgical transcranial approaches provided a direct route to the anterior surface of the posterior clinoid process. The transnasal endoscopic approach with far-medial extension ensured a statistically larger exposure of jugular tubercles as compared with other approaches. Presigmoid approaches provided a relatively limited exposure of the ipsilateral clivus, which increased in proportion to their invasiveness. CONCLUSIONS This is the first anatomical study that quantitatively compares in a holistic way exposure and working volumes offered by the most used modern approaches to the clivus.

中文翻译：

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经鼻和经颅方法对锁骨的定量解剖比较。

背景与目的1990年代初期，人们把“人形地带”定义为“无人区”，但是从那以后，人们就描述了多种方法来使用它。这项研究的目的是使用最近开发的研究方法，在临床前环境中定量比较内窥镜经鼻和显微外科经颅入路对锁骨的治疗方法。方法对5例接受了高分辨率计算机断层扫描（CT）的头颈部标本进行了多种处理：鼻内窥镜经鼻（经斜肌，体位低下，远中延伸），显微外科前外侧（眶上，微型，翼状，翼状，翼状trans骨） ，额颞眶-合），外侧（颞下及颞下合zy）和后外侧（类乙状结肠，远侧，后迷路，经迷路，和耳蜗）。使用光学神经导航系统和专用软件来量化每种方法的工作量，并计算不同脊柱区域的暴露量。具有随机交集的混合线性模型用于统计分析。结果与显微外科经颅入路相比，内窥镜经鼻入路显示出更大的工作量和更大的暴露。经鼻内镜经腹腔镜行硬膜内穿刺活检可增加上颌骨的暴露。前外侧显微外科经颅入路为后类斜突的前表面提供了直接途径。与其他方法相比，经鼻内窥镜远距离内伸入术可确保颈椎结节的统计学上更大的暴露。乙状结肠前入路提供了相对有限的同侧锁骨暴露，其随其侵袭性的增加而增加。结论这是第一项以整体方式定量比较最常用的现代锁骨方法提供的暴露量和工作量的解剖学研究。