The endoscope-assisted ventral approach compared with open microscope-assisted surgery for clival XXXX .

@entity129 @entity1 @entity5 @entity693 @entity79 @entity5173 @entity3580 @entity86
BACKGROUND: The current management paradigm for clival @entity3580 includes cytoreductive surgery with adjuvant radiotherapy. Surgical approaches have traditionally utilized the microscope to remove these lesions through approaches that require extensive @entity79 , brain retraction, and mobilization of normal anatomy to create a suitably large corridor. The endoscopic ventral approaches provide a direct route to the @entity5 using natural orifices. Little data exist comparing these 2 surgical strategies. We conducted a systematic review of case series and case reports in hope of furthering our understanding of the role of endoscopy in the management of these difficult @entity129 . METHODS: We performed a MEDLINE (1950 to 2010) search to identify relevant studies. Statistical analyses of categorical variables such as extent of resection, morbidity, and visual outcome were carried out using chi-square and Fisher exact tests. RESULTS: Thirty-seven studies, involving 766 @entity1 , were included. Compared with the open surgery cohort, the endoscopic cohort had a significantly higher percentage of gross total resection (61.0% vs. 48.1%; P = 0.010), fewer @entity129 (1.3% vs. 24.2%, P < 0.001), fewer incidences of @entity693 (0.9% vs. 5.9%, P = 0.029), less mortality (4.7% vs. 21.6%, P < 0.001), and fewer local recurrences (16.9% vs. 40.0%, P = 0.0001). There was no significant difference in the incidence of @entity86 (P = 0.084). Follow-up was longer in the open compared with the endoscopic cohort (59.7 vs. 18.5 months, P < 0.001). CONCLUSIONS: Our systematic analysis supports the endoscopic ventral approaches as a safe and effective alternative for the treatment of certain clival @entity3580 . Although the overall literature supports this technique in carefully selected @entity1 , longer follow-up is needed to more definitively address therapeutic efficacy. Careful @entity1 selection and meticulous multilayer closure are critical to obtaining maximal resection and acceptably low @entity5173 rates.
