Opening New Window in Upper Clival Region: Results from Anatomic Study

Considering its position located anteriorly to the brainstem, the retrosellar area, in particular the upper clival region and the interpeduncular cistern, is one of the most difficult regions to surgically approach. To date, many different operative solutions have been described, given that this region is attainable by both lateral and median approaches. Lateral routes include the frontolateral, subtemporal, and frontotemporozygomatic approaches with relative variants that have been extensively reported. Among the lateral approaches, the frontotemporozygomatic one is considered particularly useful because it allows better visualization of the retrosellar and suprasellar areas minimizing the working distance and brain retraction. However, such an approach is based on extensive bone removal. Median routes involve principally the transsphenoidal approaches. Accordingly, the lateral approaches expose the target area starting from a lateral entry point, while the median approaches reach the area of interest throughout a median way. Overall, considering the complexity of the upper clivus approach is technically demanding, each has specific limitations and some exposures have precise indications.