The role of endoscopic biopsy from intra clival lesions

The role of endoscopic biopsy from intra clival lesions. Objectives: Intra clival lesions typically present a diagnostic challenge due to limited access for tissue biopsy and the proximity of vital structures. This study’s aim was to evaluate the role of endoscopic biopsy from intra clival lesions. Hypothesizing that biopsy can spare the need for surgery in many cases. Materials and methods: Data was collected on all patients who underwent endoscopic biopsy of intra clival lesions in a tertiary medical center during 2003-2013. All patients included had normal appearing nasopharynx and an intact nasopharyngeal mucosa. Results: Of the 16 patients found, 15 had undergone endoscopic biopsy from the clivus itself and one from the occipital condyle (para-clival). Of the 16 clival biopsies performed, in 15 patients the trans-nasopharyngeal approach was used, in one patient the approach was trans-sphenoidal. All patients were preoperatively evaluated with enhanced computerized tomography scan and magnetic resonance imaging. Surgical navigation system was used in six procedures. There were no reported complications. Pathology results included: osteomyelitis (6), nasopharyngeal carcinoma (2), chordoma (2), plasmacytoma (2) (one with co-existing tuberculosis infection), metastatic prostatic carcinoma (1), metastatic sarcoma (1), epidermoid cyst (1), fibromixoid tumor (1). Following biopsy, the pathology result enabled non-surgical management in 14 patients (87.5%). Two patients were successfully treated by endoscopic surgery. Conclusions: Intra clival lesions can be efficient and safely diagnosed using trans-nasopharyngeal or trans-sphenoidal endoscopic techniques. Correct diagnosis from this remote region may obviate the need for surgery in many cases.