Stereotactic biopsy approach to the upper clivus through the middle fossa floor that avoids pneumatised cavities and the intradural compartment

BACKGROUND: Biopsies of clival lesions are usually performed, under general
anaesthesia, through an anterior endoscopic approach or, alternatively, through a
trans-nasal or trans-oral stereotactic approach.
METHODS: A 57-year-old man with a symptomatic osteolytical lesion of the clivus,
who refused general anaesthesia, underwent a sterotactically guided biopsy of the
lesion by an antero-lateral approach through the temporal and sphenoid bones.
RESULTS: Biopsy was successfully performed and the resulting diagnosis was
myeloma. The patient was comfortable during and after surgery and there were no
complications.
CONCLUSIONS: The present stereotactic antero-lateral approach to the biopsy of
the upper clivus can be considered an useful adjunct to the current trans-oral
and transnasal approaches that often require general anaesthesia.