Tuğba MORALI GÜLER, Ömer Faruk ÜNAL, Gökmen KAHİLOĞULLARI

The radiological anatomy of clivus for surgical approaches

Objectives: Clivus is the central part of the skull base that extends from the anterior part of the foramen magnum to the posterior clinoid process. Clivus has close relationships with crucial neurovascular structures. The purpose of the study was to evaluate the anatomical relationships at the clival region on computed tomography (CT) images for to provide data to conduct best pathways and safe zones for clival surgeries. Methods: Brain and cervical CT images of 103 patients (48 female, 55 male; mean age: 63) were examined retrospectively. The length of the clivus at the sagittal plane, the width of the inferior and middle parts of the clivus at the midsagittal plane, and the distance between the internal carotid arteries at the sagittal plane in axial sections were measured. Results: The mean length of the clivus at the sagittal plane was 38.40±5.82 mm. The mean width of the inferior and middle parts of the clivus at the midsagittal plane was 6.67±1.45 mm and 10.32±1.66 mm, respectively. In axial sections, the mean distance between the internal carotid arteries was 22.10±03.42 mm in the sagittal plane. Conclusion: Knowing the dimensions of the clivus and the distance between the internal carotid arteries at the sagittal plane is important for a safe and successful clival surgery.

Keywords:

clivus, computed tomography, skull base,

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Rai R, Iwanaga J, Shokouhi G, Loukas M, Mortazavi MM, Oskouian RJ, Tubbs RS. A comprehensive review of the clivus: anatomy, embryology, variants, pathology, and surgical approaches. Childs Nerv Syst 2018;34:1451–8.
Hofmann E, Prescher A. The clivus. Clin Neuroradiol 2012;22:123–39.
Cheng Y, Zhang S, Chen Y, Zhao G. Safe corridor to access clivus for endoscopic trans-sphenoidal surgery: a radiological and anatomical study. PLoS One 2015;10:e0137962.
Stamm AC, Pignatari SS, Vellutini E. Transnasal endoscopic surgical approaches to the clivus. Otolaryngol Clin of North Am 2006;39:639–56.
Bayrak S, Göller Bulut D, Orhan K. Prevalence of anatomical variants in the clivus: fossa navicularis magna, canalis basilaris medianus, and craniopharyngeal canal. Surg Radiol Anat 2019;41:477–83.
Patel CR, Fernandez-Miranda JC, Wang WH, Wang EW. Skull base anatomy. Otolaryngol Clin North Am 2016;49:9–20.
Nardi C, Maraghelli D, Pietragalla M, Scola E, Locatello LG, Maggiore G, Gallo O, Bartolucci M. A practical overview of CT and MRI features of developmental, inflammatory, and neoplastic lesions of the sphenoid body and clivus. Neuroradiology 2022;64:1483–509.
Anik I, Koc K, Cabuk B, Ceylan S. Endoscopic transphenoidal approach for fibrous dysplasia of clivus, tuberculum sellae and sphenoid sinus; report of three cases. Turk Neurosurg 2012;22:662–6.
Wang SS, Li JF, Zhang SM, Jing JJ, Xue L. A virtual reality model of the clivus and surgical simulation via transoral or transnasal route. Int J Clin Exp Med 2014;15:3270–9.
Koenigsberg RA, Vakil N, Hong TA, Htaik T, Faerber E, Maiorano T, Dua M, Faro S, Gonzales C. Evaluation of platybasia with MR imaging. AJNR Am J Neuroradiol 2005;26:89–92.